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12. Laser Therapy in Urology with Usage of Mustang 2000, Mulat-M10 Laser Devices
and Mustang-VACUUM-DynaVac Vacuum Massage Device

M.L.Mufaged, L.P.Ivanchenko

Nonspecific inflammatory diseases of the genitourinary system (GUS) organs are among the most common urological troubles and come second to the acute respiratory diseases only for the frequency of occurrence. According to the data from N.A. Lopatkin (1998), the infectious inflammatory states in urology practices are found with very high frequency (up to 78%). Unfortunately, main group of population suffering from these diseases are young people of child producing age, the peak of diseases falls within the age of 26–41 years.

There are primary inflammatory affections of various GUS parts: pyelonephritis, cystitis, prostatitis, epididymo-orchitis, and secondary processes, which develop in connection with the diseases of other organs and systems. Also, complications after various operative and instrumental interventions occur. The nonspecific inflammatory processes in GUS having an iatrogenic genesis are worthy of special attention because a successful control of them influence pronouncedly both, the quality of living of the diseased people and the level of medical treatment of the population as a whole.

Conventionally applied treatment modalities of inflammatory diseases of kidneys, urinary tract and male genital organs not always satisfy the clinicians with their results. Insufficient effectiveness of treatment employing the routine methods is caused most commonly by a range of factors:

• impaired circulation in an affected organ;

• innervation disorder (of functional nature);

• impairment of bioavailability of organs for antibacterial and anti-inflammatory medicines.

These factors are connected with a variety of causes, main of which are: oedema of affected organ tissue, suppression of microcirculation in the region of inflammation and presence of various barriers. All this drives to look for the new ways of solution of this issue by making use of the present-days achievements of science and technology. Low-level laser therapy (LLLT) is one of such innovative methods of medical treatment, which is increasingly applied in urology practices from year to year and open up the new opportunities and prospects in treatment of GUS inflammatory diseases.

We examine in this paper certain proprietary treatment techniques of a wide range of urologic diseases of inflammatory genesis. Each of these diseases and methods of laser therapy has its particularities, which are set out in the following sections.

Often, sexual disorders are connected with chronic infectious diseases of genitourinary sphere both, indirectly and directly. Therefore, we do not specify this section in a separate chapter and just point up additionally an emotional and psychological side of solution of this issue.

Before the reader becomes familiar with the material presented therein, we draw particular attention to some critical points:

• magneto-laser therapy of GUS inflammatory diseases may be applied as a sole treatment in very rare cases only, but most often as
        a part of a multimodality therapy;

• patients with kidney diseases must undergo any treatment at in-patient facilities only and under the control of specialists;

• laser therapy should be accompanied with intake of antioxidants.

1. Amyloidosis

Amyloidosis is a complex anomaly of protein and carbohydrate metabolism, which results in formation of a special substance – amyloid fibrous protein, in the internal organs and systems. Nowadays, there is found out the heterogeneity of amyloid fibrils which localize perireticularly or around collagenous fibres that is accompanied with dysfunction of certain organs: kidneys, lungs, heart etc.

The preventive measures are focused largely on the secondary amyloidosis and are aimed at the control of infections. Within the period of sufficient renal function the patients should take adequate nutrition with moderate restriction of cooking salt if any oedema. In case of renal insufficiency the treatment modality shall be changed depending on intensity of clinical signs.

Application of intravenous laser blood irradiation (ILBI) in the course of treatment of AA-amyloidosis in the patients with rheumatoid arthritis (RA) using the method described below in the course of routine treatment methods showed better results.

Laser therapy (LT) technique: intravenous laser blood irradiation (ILBI) using Mulat-M10 laser therapeutic device (Fig. 1), optical radiation power at the light-guiding fiber output 1.5–2.0 mW, 10–12 daily sessions, duration of a session 25-30 minutes.

Fig. 1. Mulat-M10 laser therapeutic device

Repeated course of laser therapy in 6 and 12 months. Then the courses of laser therapy are repeated every 12 months during not less than 5 years when possible.

2. Sterility

According to the contemporary literature, up to 12–15% of married couples are sterile, including through the husbands fault in 40–45% of the cases [Kamalov A.A., 2000; Tarasov N.I. at al., 1999]. In the general structure of the male sterility causes the existing inflammatory diseases of genital organs come steady second – third that made it possible to classify a separate form of sterility – excretory toxical [Yunda I.F., 1990], or excretory inflammable [Guidance on Andrology, 1990].

Conventional medication therapy in case of chronic inflammatory diseases of the reproductive system organs though not always normalizes the fertility that makes the researchers look for alternative, in particular, drug-free modalities of male sterility. They include also magneto-laser therapy (MLT). The available medical books present single statements of local MLT application in spermatogenesis pathology, which is usually of complementary nature and prescribed along with the medication or at the final stage of conventional treatment [Avdoshyn V.P. at al., 1994].

Meanwhile, it has been known that LLLT, both, continuous red (0.65 m), and pulse IR (0.89 m), in vivo, and in vitro, makes a stimulation effect on the sperm – the energetic processes are improved. Moreover, exposure to pulse IR-irradiation is more effective at the optimum exposure time of 5 minutes [Goryunov S.V., 1996].

Researches by V.V. Yurshyn (2003) proved that increase of sex and gonadotrophic hormones content in the blood serum of the patients having excretory inflammatory form of sterility is observed at the time when MLT is applied with its peak in the middle of 10-day course of treatment. The level of lactotropic hormone is conversely reduced within the same time period, and the tendency for normalization of all indices is observed in a month.

In V.V. Yurshyns opinion (2003), differences in directional orientation of response of gonadotrophic and lactotropic hormones of hypophysis are caused by MLTs action not directly on hypophysis, but through the hypothalamus, wherein the products of gonadoliberin realising factor and prolactin inhibiting factor are coupled causing, in turn, an increase in secretion of follicle-stimulating and intestinal cell-stimulating hormones while prolactin hormone formation is inhibited. Increase of the level of reproductive hormones is connected with both, hypophyseal stimulation of endocrine function of testes, and reflex action on genital glands through the vegetal nervous system (VNS); moreover, MLT promotes the line intestinal cell-stimulating hormone – testicular hormone, and it should be applied in asthenozoospermia and oligospermia with pronounced sperm motility impairment.

The pregnancy incident of wives of these patients was 41.7 and 55.4% respectively, and they gave birth in 35.8 and 49.7% of the cases. In the course of the given treatment of patients with excretory inflammable form of sterility using MLT, a positive therapeutic effect was achieved in 95% of the cases, remission of more than 1 year was observed in 85% of the examined patients [Yurshyn V.V., 2003].

Other researches also speak about promising outlooks of LLLT in the complex treatment of patients suffering from secretory sterility. Thus, it was demonstrated that the sperm motility (a + b) is truly increased after LLLT exposure from 17 to 29% ( = 0.0002 – by sign test), number of morphologically normal forms from 25 to 35% ( = 0.0001 – by sign test), number of viable sperm from 60 to 66% ( = 0.04 – by sign test).An analysis of the hormonal panel showed the tendencies for reduction of follicle-stimulating hormone (FSH) level in the patients suffering from the pronounced oligoasthenoteratozoospermia from 11.5 mIU/ml to 8.0 mIU/ml ( = 0.05 – by sign test, = 0.09 – by the Students coefficient) that is indicative proximately of LLLT effect on the Sertolis cells [Mazo E.B. et al., 2002; Mufaged M.L. et al., 2004].

LT technique: transcutaneous contact MLT using Mustang 2000 or Mustang 2000+ laser therapeutic device (Fig. 2). LO4-2000 laser radiation probe (Fig. 3) with ZM50 magnetic attachment (50 mT) (Fig. 4), output radiation power 10–15 W, frequency 80 Hz.

Fig. 2. Laser therapeutic device (basic unit) of Mustang 2000+ series

Fig. 3. Appearance of laser radiation probes of pulse radiation

Fig. 4. ZM50 magnetic attachment

Exposure of testicles to bipolar laser radiation is carried out in succession within 5 min. for each testicle, and then within 2 min. within the area of edgebone and perineum. The course consists of 10 daily sessions.

3. Glomerulonephritis

Glomerulonephritis (GN) is a kidney inflammatory disease of immune genesis with the primary and major affection of glomeruli, as well as with involvement of other structural elements of renal tissue into pathological process; has a steadily progressing course with outcome into chronic renal insufficiency (CRI). The glomerulonephritis is subdivided into immunoinflammatory nephritis (membranoprofilerative glomerulonephritis and mesangiocapillary glomerulonephritis) and non-inflammatory nephropathies (membranous glomerulonephritis, focal segmental glomerulosclerosis).

Treatment of the patients suffering from GN is rather difficult and complicated task. Main task of the treatment is confined to inhibition of immunoreactions by cytostatic and/or glycocosticosteroid agents. In case of GN, the possibility of absolute recovery is in in doubt, and if it happens, it is just in single cases. Oftener, it is possible to reach more or less full or partial remission of different duration. Therefore, the primary aim in GN treatment is to slowdown the rate of the disease progression and to prevent the course of chronic renal insufficiency, to get the remission (clinical or clinic-laboratorial) as long as possible and to maintain the patients capacity to work and quality of living for an extended period. The treatment of the patients with GN should be complex and include prescription of a regime, which corresponds to the state of the patient and course of disease, various health aids, reasonable diet therapy and sanatorium-resort methods if possible.

Improvement in the patients health status suffering from glomerulonephritis after application of LLLT consists in normalization of the state of health, blood pressure stabilization, improvement of the functional renal tests, decreased activity of inflammatory process with development of clinic-laboratorial remission, reduced proteinuria, increased diuresis [Greenstein Yu.I., 1995; Sleptsova T.G. et al., 1995].

In view of stages and elements of the glomerulonephritis pathogenesis, it can be assumed that these benefits in the treatment of glomerulonephritis using LLLT come thanks to induction of catalase, superoxide dismutase (SDM) ferment strength, which abrogate the pronounced lipid peroxidation in the form of reduction of intermediate products of lipid peroxidation (diene conjugates and malondialdehyde). The cholesterin quantity

and content of free membrane fatty acids in the lymphocyte membranes in the patients suffering from glomerulonephritis are truly increased, and the quantity of general lipids, cholesterin, and triglycerides is reduced in the blood serum. Moreover, the repair of rheological disorders occurs as a result of true reduction of erythrocyte deformability [Greenstein Yu.I., 1995].

Protracted application of LLLT has a positive effect on hemodynamic regardless of the clinical variant of glomerulonephritis process – promoting transition of hyperkinetic and hypokinetic types of the blood circulation into normokinetic. Because of the fact that forecasting unfavourable types of blood circulation occur oftener at the mixed clinical variant of progress and nephrotic syndrome, the percentage of transition is more than in the patients suffering from the isolated urinary syndrome [Lutoshkin M.B., 2003].

Laser therapy is indicated by the method of intravenous laser blood irradiation. ILBI is accompanied by a pronounced positive effect on the basic clinical presentations of hypertensive syndrome against reduction of arterial blood pressure that makes it possible to cancel the intake of specific antihypertensive drugs for more than one fourth of the patients, and for other patients – to reduce the basic antihypertensive therapy by more than twice, in so doing to decrease the quantity of the medications taken and to make the treatment cheaper. Taking into account some tensity of antioxidant protection system in the patients organism suffering from GN, antioxidants are prescribed for the patients. Most commonly, it is Polyoxidonium at the dose of 6 mg daily.

LT technique: ILBI using Mulat-M10 laser therapeutic device, continuous radiation wavelength 0.65 m, optical radiation power at the light-guiding fiber output 1.5–2.0 mW, duration of a session 30 to 45 minutes. Treatment course consists of 10–12 sessions. Repeated courses in 3, 6, 9 months to consolidate the treatment achievements or for preventive reasons.

4. Diabetic nephropathy

It is generally thought that hyperfiltration and intraglomerular hypertension underlie the progression of both, non-diabetic and diabetic renal insufficiency. Moreover, in case of diabetes, common multisystemic, inclusive of renal, polyneural angiopathy occurs, which results, in turn, in impairment of blood circulation in kidney parenchyma. The angiotensin-converting enzyme inhibitors and natural antioxidant and aneoprotector α-lipoic acid are considered to be well-established medicaments for treatment of this dangerous complication. The improvement rate of the indices and their further maintenance at the achieved level after implementation of these groups of medicaments is better in the patients which treatment is carried out on the back of laser therapy.

Laser therapy is carried out in accordance with a complex method as a part of a multimodality therapy.

Technique 1: ILBI using Mulat-M10 laser therapeutic device. The first 5 sessions are carried out by intravenous blood irradiation within 25–30 minutes with optical radiation power at the light-guiding fiber output 1.5–2.0 mW, wavelength 0.65 m. In the course of ultra-violet irradiation (UVI) of blood the exposure time 5–7 min., radiation power 1 mW, wavelength 365 nm (Mustang 2000 or Mustang 2000+ laser therapeutic device, VLOK-LED-365 laser radiation probe (Fig. 5)).

Fig. 5. Appearance of VLOK-LED-365 light-emitting diode radiation probe

Technique 2: transcutaneous contact MLT using Mustang 2000 or Mustang 2000+ laser therapeutic device. The following 5–7 sessions. There is carried out an exposure of kidney projections to radiation symmetrically by pulse IR-laser probe of MLO1K-2000 matrix type (wavelength 0.89 m) (Fig. 6) with MM50 magnetic attachment (50 mT) (Fig. 7), pulse recurrence frequency 80 Hz, output radiation power 40–50 W within 1.5–2 min. per zone. Decades-long researches showed that the pulsed laser radiation of red spectrum – LOK2-2000 laser radiation probe, makes more effective an action on the vascular system (Fig. 3), output radiation power 3 W, wavelength 0.63–0.65 m also within 1.5–2 min. per zone  (Mustang 2000 or Mustang 2000+ laser therapeutic device).

Fig. 6. Appearance of MLO1K-2000 laser radiation probe of matrix type

I. View of display panel. II. View of window for radiation outlet.

Fig. 7. MM50 magnetic attachment

The repeated courses are carried out in 3 and 6 months. During the following 5-10 years a course of laser therapy must be carried out once per year.

All the patients receive a complex therapy for underlying disease, pancreatic diabetes, with consideration of type, variant and severity level of the underlying disease.

The LT sessions carried out improve the quality of the patients living by reducing, mitigating the intensity of the clinical presentations of uremic intoxication and the pancreatic diabetes itself – polyneuropathy, angiopathy, skin itch, dyspeptic disorders. The data available are eloquent of general positive effect of LLLT on the kidney function state in the patients suffering from pancreatic diabetes in the event of development of diabetic nephropathy [Lutoshkin M.B., 2003].

5. Steinstrasse after extracorporeal shock wave lithotripsy

Large-scale implementation of the method of extracorporeal shock wave lithotripsy of kidney and ureter calculi in the clinical practice has aggravated a problem of prevention of ureteral occlusion by small fragments of destroyed calculi and the relevant complications. The new technical capabilities in the field of extracorporeal shock wave lithotripsy make it possible to destroy the calculi completely in 90–95% of the cases. However, the major problem lies in evacuation of the destroyed calculus fragments from different parts of ureter. Despite the fact that in most cases the size of the fragments of the destroyed calculus in the form of steinstrasse is not more than 2–3 cm, weeks and sometimes months are required for their passage. Unfortunately, the currently used methods of non-operative, medicamental, physiotherapeutic action on a calculus or destroyed calculus fragments not always result in achievement of the desired effect. That is exactly why application of LT, taking into account its pathogenetic capabilities (antiedematous, analgesic, enhancing the contractility of ureter wall action etc.) is justified in treatment of this category of the patients  [Alekseev A.V. et al., 2002].

It was discovered the stimulating effect of LLLT on the urodynamic of the upper urinary tract, change in amplitude and frequency of peristalsis. The therapy by pulsed IR laser radiation appeared to be the most effective, makes it possible to vary the parameters of effect [Safarov R.M. et al., 1996].

V.P. Avdoshyn (2000) has suggested a technique which lies in combination of conventional treatment modalities (spasmolysants, uroseptics, urinative herbs, medications of terpenes group) with carrying out of LT. It is used pulsed IR radiation (laser probe of LO4-2000 type), output radiation power 4–7 W, pulse recurrence frequency 1000–1500 Hz, using scanning technique, no less than on 3 zones: 1st zone – projection of ureter below the localization of  steinstrasse, 2nd projection – projection of steinstrasse, 3rd – kidney protection by two fields on the side of affection. Duration of a session - 5–10 min. for each zone. LT sessions are carried out until removal of steinstrasse from the urinary tract.

Other data evidences the pronounced therapeutic effect of MLT  on the process of passage of calculus fragments from the urinary tract after  extracorporeal shock wave lithotripsy compared with conventionally used treatment methods (medicamental and physiotherapeutic). The usage of MLO1K-2000 matrix pulsed laser radiation probe with MM50 magnetic attachment appeared to be the most effective [Khalyastova E.A et al., 2002].

Technique: contact transcutaneous MLT using Mustang 2000 or Mustang 2000+ laser therapeutic device. MLO1K-2000 laser radiation probe with MM50 magnetic attachment (50 mT), maximum output radiation power 50–80 W, pulse recurrence frequency 1000–1500 Hz. The first day – an action on projection of calculus or steinstrasse and on projection of ureter segment located below the calculus; 2nd day – action by MLT on the same point and on the kidney projection; 3rd and following days – action by MLT on all 3 fields. Time of exposure on each point – 5 min. The course consists of 8–10 daily sessions. All patients are treated with spasmolytic, analgesic and antibiotic drugs to prevent the development of inflammatory complications [Khalyastova E.A. et al., 2002].

6. Magneto-laser therapy under hemodialysis, after kidney transplantation

The patients on hemodialysis or after kidney transplantation suffer often from various complications and critical conditions, in which it is not always useful or it has no sense to apply already known treatment techniques or modalities for various reasons.

In the first place, this is progression of cardiovascular insufficiency in the form of ischemic heart disease, myocardial infarct, pericarditis, arterial hypertension etc. Septic and cerebrovascular complications are the next. Haemorrhages of different localization may cause fatal cases of the patients that are promoted by application of large doses of heparin during the session. Moreover, the disease process and blood transfusions carried out result in growth of pre-existing antibodies in the patients organisms, and their high titre makes it impossible to perform a life and death surgery intervention – transplantation of kidney.

It is well known that the hyperkinetic variant of heart insufficiency is developed in most patients receiving treatment by program hemodialysis. Application of cardiac glycosides is not recommended under such conditions since it may contribute to further progression of circulatory insufficiency. Therefore, there is a necessity of further study of the new alternative approaches and techniques of cardiac insufficiency correction in such patients [Lutoshkin M.B., 2003].

Laser therapy of the patients with terminal renal insufficiency receiving the treatment by program hemodialysis  results in decrease of development of complications by  55–60%, reduction in total peripheral resistance and improvement of cardiac function, positive reduction of the level of triglycerides, pre-beta-lipoproteids, cholesterin, normalization of lipid peroxidation processes, improvement of activity indices of oxidation – reduction processes, improvement of microcirculation connected with dilation of capillaries and improvement of rheological blood values based on the coagulogram data. It is noted smoother course of uremic pericarditis and decreased lethality, shortened periods of disease in case of suppurative-septic complications, their resolution passed faster than in the control group due to reduced endogenous intoxication (the level of urea, creatinine, medium molecules), as well as elimination of immunological paralysis condition after pronounced immunodepressive therapy carried out in connection with the transplanted kidney rejection episodes [Zakharov V.V. et al., 1995; Lebedkov E.V., 1995; Sernyak P.S. et al., 1995].

After ILBI a true reducing of subjective and objective signs of cardiac insufficiency is noted on average in the whole group of the patients examined. A true tendency for decreased laboured breathing, fatigability, orthopnoea is identified. The severity of cardiac insufficiency as per classification of the New-York Cardiological Society is decreased from 3.4 0.3 to 2.8 0.31 class ( < 0.05). All examined patients have increased myocardial contractility by 6.4% ( < 0.05) with the concurrent contraction of the left ventricle: end-diastolic volume (EDV) – by 5.8% ( < 0.05), end-systolic volume (ESV) – by 6.5% ( < 0.05). In the course of dynamic study of the microcirculatory bloodstream condition, reduction in perivascular oedema, regeneration of arterial and venular bypasses, increase of blood velocity is observed. Identification rate of sludge-syndrome was reduced from 92 to 45%, arterial-venular index has increased from 0.18 0.01 to 0.32 0.017 ( < 0.05) [Lutoshkin M.B., 2003].

Technique: ILBI by means of Mulat-M10 laser therapeutic device. Optical radiation power at the light-guiding fiber output 2.5–3.0 mW, wavelength 0.65 m, duration of a session 50–60 minutes, 10 sessions per treatment course.

7. Urolithiasis

We have used three principal directions in approach to the issue of therapy using MLT in treatment of urolithiasis (ULT): treatment of ULT itself (litholysis), lithokinesis and lithiasis.

The patients with urolithiasis are the most frequent patients of urological clinics – up to 40% of the total number of urological patients. The application of extracorporeal shockwave lithotripsy in the therapy of the patients with urolithiasis makes it possible often to solve the problem, but a range of complications are possible (renal colic, aggravation of an urinary infection, obstruction of the upper urinary tract with the fragments of destroyed calculus, with development of acute obstructive pyelonephritis).

Owing to main therapeutic features of LLLT, its application is the most effective in combination with the conventional treatment methods of patients with renal colic. Such technique makes it possible to accelerate rapid relief of renal colic symptoms, to increase the intervals between the episodes. Passage of calculi on the background of such therapy goes often painless [Avdoshyn V.P., 2000].

The laser therapy in case of renal colic is carried out in the scanning mode on the projection zones of ureter below the calculus localization, calculus projection, and kidney projection by two fields. Pulse IR-radiation probe (LO4-2000 type), pulse recurrence frequency 1000 Hz, pulse radiation power 5–7 W, duration of one session 5 min. on each zone. LT sessions are carried out daily until the calculus went out of the urinary tract [Avdoshyn V.P., 2000].

Application of magneto-laser therapy for the patients with urate nephrolithiasis is justified in connection with the stabilizing effect on the membranes resulting in normalization of colloid systems. The normalization of uric acid indices in the blood serum and in urine is reached on the 5th day of therapy. V.P. Avdoshyn et al. (2001) showed conclusively that application of MLT in a complex therapy aimed at prevention of the secondary prophylaxis of lithiasis is pathogenically substantiated and reasonable. According to Kh.F. Lakhlu (2001), application of MLT in a complex treatment and prevention of a disease makes it possible to prevent calculus formation in the patients with urate nephrolithiasis in 96.6% of the cases and in the patients with oxalate nephrolithiasis in 100% of the cases.

Technique 1: transcutaneous contact MLT using Mustang 2000 or Mustang 2000+ laser therapeutic devices. Within preoperative stage. Two radiation probes of LO4-2000 type with ZM50 magnetic attachments, frequency 1500–3000 Hz, pulse radiation power 8–12 W. Transcutaneous contact-mirror action (Fig. 8) parasternally (zone 1) at the level of the second intercostal space, then on inguinal vascular fascicles (zone 4) within 2 min. on each, and on projection zone of calculus front and rear (zones 2, 3) within 4 min. on each  – radiation probes shall be moved slowly down within the zone of 12–15 cm length. Action is repeated in 4–6 h. In many cases, the magneto-laser therapy carried out according to this scheme against increased fluids and medication (spasmolytic, analgesic drugs etc.), promotes passage of calculi and cancellation of surgery.

Fig. 8. Magnetic laser therapy technique in urolithiasis

Technique 2: transcutaneous contact MLT using Mustang 2000 or Mustang 2000+ laser therapeutic device. After the calculi have been passed (or in postoperative period) the magneto-laser therapy is carried out on a daily basis within 5–7 days 1–2 times per day. Action is made on the area of affected kidney (zone 3) and on inguinal vascular fascicles (zone 4) within 2 min. on zone. MLO1K-2000 matrix pulse IR-radiation probe with MM50 magnetic attachment, output radiation power 40–50 W, pulse recurrence frequency 600–1000 Hz.

8. Acute pyelonephritis

In addition to the general principles of acute pyelonephritis treatment when selecting MLT therapy technique, a pathogenic factor which caused the development of disease is of paramount importance. According to the conventional classification the following pathogenic ways of infectious agent penetration into a kidney are distinguished: hematogenic, ascending urinogenic and ascending along the ureter wall. Thus, for instance, in case of hematogenic way of infection penetration, pockets of infection in the organism shall undergo magneto-laser treatment. In case of the urinogenic way the treatment using ILBI and magnetic therapy (MT) of infectious diseases of small pelvis organs should be provided. In case of ascending along the ureter wall type of spread of infection it is necessary to apply the technique described in section related to the treatment of chronic interstitial cystitis. Transcutaneous LT is indicated for treatment of all types of acute pyelonephritis for the purpose of improving the microcirculation in parenchyma of the affected kidney; intravenous laser blood irradiation – in case of pronounced depression of cell- and antibody-mediated immunity; a combined technique - in case of any suppurative-septic diseases of kidneys with pronounced intoxication.

According to V.P. Avdoshyn et al. (2005), after carrying out magneto-laser therapy in complex treatment of acute pyelonephritis in main group, the normalization of indices of physical, laboratory and ultra-sound testing occurs at an earlier date that in the control group. In main group (as against of control one) a tendency for normalization of ELI-P-test-1 values is observed. Moreover, the repeated attacks of acute pyelonephritis during this pregnancy and after delivery were noted more rarely among the patients of main group, premature births were observed more rarely. Moreover, they delivered the babies with better characteristics as per Apgar scale and with higher body weight compared with the babies delivered by females of the control group. Application of MLT in the complex treatment of acute pyelonephritis within the 2nd half of pregnancy is effective not only in the treatment of the disease itself, but also it decreases the probability of the repeated pyelonephritis attacks during the pregnancy and after delivery, as well as it makes it possible to improve the forecast regarding the physical condition of the new born.

Technique 1: transcutaneous contact MLT using Mustang 2000 or Mustang 2000+ laser therapeutic device. Exposure of kidney projection to MLO1K-2000 laser probe with MM50 magnetic attachment, output radiation power 40–50 W, frequency 3000 Hz, in sequence within 4–5 min. per zone. Number of sessions - not more than 10, daily or every second day.

Technique 2: ILBI using Mulat-M10 laser therapeutic device, wavelength 0.65 m; radiation power 1.5–2 mW within 10–20 min., 7–10 sessions on a daily basis or every second day. Ultraviolet irradiation (UVI) of blood: exposure time 3–5 min., radiation power 1 mW, wavelength 365 nm (Mustang 2000 or Mustang 2000+ laser therapeutic device, VLOK-LED-365 radiation probe).

9. Acute and chronic cystitis

Cystitis is an inflammation of urinary bladder. The disease is of frequent occurrence among women of childbearing age. Introduction of infection occurs by ascending tract along the lumen of urethra; moreover, bigger danger of cystitis occurrence for women is determined by anatomic topography features of genitourinary tract structure: short urethra, close anatomical position of sheath and fundament to the external urethral opening, structure features of Lieutaud body epithelial layers, urethra and vaginal opening, as well as high occurrence rate of inflammatory diseases of genital organs. These factors create favourable conditions for localization and spread of continuously vegetating microflora into one of the organs of genitourinary tract and conversion of the process into chronic form of disease.

Acute cystitis is a disease with the most frequent occurrence in everyday medical practice, especially in outpatient conditions. The diagnostics of acute cystitis creates, as a rule, no problem for any doctor. The treatment includes prescription of antimicrobial medicines, dietary intervention with exception of spicy and irritating food. A pronounced therapeutic effect is observed if LT is included in a set of curative measures, which may be started since the patient seeks medical advice [Avdoshyn V.P., 2000].

The laser therapy is carried out simultaneously by means of MLO1K-2000 pulse IR-matrix radiation probe and LO4-2000, by pairs, on the projection area of urinary bladder (zone 6), on LV acantha (zone 4), kidneys (zone 2), inguinal vascular fascicles (zone 5) and zones 1 and 3 (Fig. 9). Pulse recurrence frequency 80 Hz, exposure time 1.5–2 min., radiation power 60 and 7 W respectively, number of sessions – not less than 5. As a general rule, already after the second-third session the patients urination is normalized, dysuria disappears.

Fig. 9. Magneto-laser therapy technique if cystitis

If acute cystitis is accompanied by inflammatory diseases of genital organs, consecutive irradiation of urinary bladder projection and uterine appendages using MLO1K-2000 laser probe (with the same parameters) is carried out or irradiation of urinary bladder projection using LO4-2000 laser probe and simultaneous, using the same probe with vaginal attachment of type G-1 (Fig. 10) for Mustang 2000 or Mustang 2000+ laser therapeutic device. Exposure time – 5 min. on each area, number of sessions – not less than 7.

Fig. 10. G-1 vaginal attachment

Chronic cystitis requires longer-term treatment which should include, in addition to the conventional antimicrobial therapy, a intravesicular installations of various antiseptic medicines (silver preparations, Dibunolum, Synthomycin emulsion etc.) into urinary bladder. LT is carried out by means of placing emitter on the urocyst projection in suprapabic area. Exposure time - 5 min., pulse recurrence frequency 80 Hz – the first 3 sessions and sessions 7–10, frequency 3000 Hz – sessions 4–6. In specific situations, LT course may be repeated independently (with no other kinds of treatment) in 10 days after completion of the first course. The efficiency is evaluated by the status of the patient, as well as based on the data of the clinical laboratory indices.

10. Acute epididymo-orchitis

Acute inflammation of appendage – acute epididymitis (AE), is one of urological diseases of the most frequent occurrence developing both, independently, and in combination with acute inflammatory process in testicle – epididymo-orchitis (AEO). More than 25% of middle-age and young men have suffered from this disease in the course of their lifetime.

In the modern medicine, the application of ILBI as one of the methods of physical action on various organs gained a wide popularity. The reason for this is that exactly ILBI has a pronounced anti-inflammatory and analgesic effect, improves general and local immunity, and improves the microcirculation in the area of inflammation influencing the penetrance of vessel walls. The most important feature of laser therapy is the fact that an effect of photo activation of biological and physiological processes in the whole organism is initiated at the local exposure.

An adequate detection of topical forms of the disease is crucial for application of differentiated disease management. In an equivalent manner it is important both, theoretically and practically, distinguishing of AE and AEO at the stage of infectious inflammatory process. For the time being, unfortunately, there is practically no standard classification of AE and AEO, which could be used by doctors in their daily work. Based on the peculiarities of clinical laboratory and sonographic changes in the appendages and testicles in case of AE and AEO, in M.L. Mufageds opinion (1995), it is reasonable to use a classification, which includes 4 stages:

• serous;

• suppurative-infiltrative;

• fine-focal suppurative-destructive;

• macrofocal (abscessed) suppurative-destructive.

It has been established that AE and AEO stage is associated, as a general rule, with remoteness of the disease in the absence of an adequate therapy. If the remoteness of disease is about 3 days, the stage I of AE develops only, if the remoteness of disease is within 5 days – stage II. If the remoteness of disease is more than 5 days, AE of the stage III develops, if more than 7 days – stage IV. The AE course depends also on kind and virulence of its invader, the immunity status of the patients organism as a whole.

AE and AEO diagnostic methods and magneto-laser therapy efficiency control are subdivided into 3 basic groups: clinical, laboratory and ultrasound methods of examination.

The clinical methods of examination include interview and study of complaints and anamnesis of the patients, examination and palpation of marsupium organs, digital rectal investigation of prostate gland.

The laboratory examination consists of clinical blood analysis, prostatic secretion analysis (PCR to detect any urogenital infection), urine and ejaculate culture, immunology research as the acute infectious inflammatory processes within the area of marsupium, and in all other organs result in significant immunological deviances in the organism which are classified as the category of the secondary immunodeficiency.

Particular importance should be paid to the ultrasound investigation as the most objective and informative method of AE and AEO diagnostic and control of the therapy efficiency in the course of treatment. Ultrasound investigation only is capable to detect truly not only the topic form (AE or AEO, primary affection of this or that segment of testicle or its appendage), but the stage of the disease, too. In the course of ultrasound investigation it is necessary to assess the size, shapes, and sharpness of contours, echostructure of testicles and epididymis, the presence of space-occupying masses, destructive changes and degree of their extension, as well as the presence of liquid in the marsupium cavity. In the serous stage a uniform decrease of echo-density is detected, in the diffuse – suppurative stage – its uniform increase, and in case of fine-focal– and macrofocal destruction – the relevant areas of increase and decrease of echo-density. U/S-monitoring makes it possible to adjust and optimize MLT doses and modes in the course of its application [Mufaged M.L., 1995].

Efficiency control of the therapy conducted is performed by method of ultrasound monitoring every three days from the beginning of the delivery of therapy. In the initial stages (I– II) of acute epididymitis without signs of the process spread on any testicle, it is recommended to continue the local magneto-laser therapy after relief of the most acute signs under outpatient treatment under medical supervision by an urologist at place of residence and U/S-monitoring until absolute recovery. In the stage IV of AEO (macrofocal suppurative-destructive) the only surgical treatment is recommended.

Laser therapy is recommended to conduct depending on the stage and topical form of the disease [Local Laser Magnetic Therapy, 2002].

In the stage I of AE (serous) MLT is applied mainly independently. Mustang 2000 or Mustang 2000+ laser therapeutic device. Transcutaneous laser irradiation of testis, epididymis of testis is performed by contact method, stationary. The recommended course – 7–10 sessions. Sessions are to be conducted on a daily basis, once per day. Radiation frequency for pulse lasers 1500 and 3000 Hz in biosynchronized mode (BIO controller is connected (Fig. 11), heart rate and respiration sensors are on the patient), exposure time on one field – 5 min.

Fig. 11. BIO controller for Mustang 2000 laser therapeutic device

Emitters location as in Fig. 12:

LO4-2000 laser radiation probe, output radiation power 7–10 W, with ZM50 magnetic attachment (50 mT) – on projection of the
        upper pole of testis;

• Simultaneously, KLO3-2000 laser radiation probe (Fig. 13), maximum output radiation power, with ZM50 magnetic attachment
        (50 mT) – on projection of the lower pole of testis.

Fig. 12. Magneto-laser therapy technique of AE in stage I (serous)

Fig. 13. Appearance of laser and light-emitting diode radiation probes of continuous radiation mode 

(completed with additional button switch of modulation mode)

Direction of radiation probes – crossed. The irradiation is conducted in within the area of projection of the head (upper pole of testis) and tail (upper pole of testis) of epididymis. Location of emitters in red and infrared spectral bands may be changed depending on localization of the epididymis affected area with consideration of crossed direction of the emitters action. However, the radiation probe in red spectrum should be directed directly on the epididymis affected area. Position of the patient – lying flat on back, on treatment couch, with legs spread. In case of one-side process, the first 5 sessions shall be conducted on the side of affection localization, the following 2–5 sessions – on both sides simultaneously. In case of two-sided process, irradiation is conducted on both halves of marsupium – bilateral in the same mode.

In the stage II of AE (diffuse, suppurative-infiltrative) magneto-laser therapy is applied in combination with an antibacterial treatment (broad spectrum antibiotics). Transcutaneous laser irradiation of testis, epididymis of testis is performed by contact method, stationary. Recommended course – 10–12 sessions. The sessions are conducted on a daily basis, once per day. Pulse recurrence frequency for pulse lasers 1500 and 3000 Hz in biosynchronized mode, total exposure time – 10 min. Location of laser radiation probes as Fig. 14:

KLO3-2000 laser radiation probe with ZM50 magnetic attachment (50 mT) on projection of the upper pole of the first testicle,
        maximum output radiation power (8–10 mW);

• Simultaneously, LO4-2000 laser radiation probe, output radiation power 7–10 W, with ZM50 magnetic attachment (50 mT) on
        projection of upper pole of the second testicle toward

MLO1K-2000 matrix radiation probe, output radiation power 50–60 W, on projection of lower poles of both testicles.

Fig. 14. Magneto-laser therapy technique of AE in stage II (diffuse, suppurative-infiltrative)

Position of the patient – lying flat on back, on treatment couch, with legs spread.

In the stage III of AE or AEO (fine-focal suppurative-destructive) magneto-laser therapy is applied in combination with an antibacterial treatment (broad spectrum antibiotics). Transcutaneous laser irradiation of testicles, epididymis of testicles is performed by contact method, stationary. Recommended course – 10–15 sessions. Sessions shall be conducted on a daily basis, 2 times per day with interval between the sessions 5–6 hours. Pulse recurrence frequency for pulse lasers 3000 Hz in biosynchronized mode, total exposure time – 10 min. per one session. Emitters location in the 1st session as in Fig. 15:

LO4-2000 laser radiation probes (output radiation power 7–10 W) and KLO3-2000 (maximum output radiation power) with ZM50
        magnetic attachments (50 mT) on projection of the upper half of marsupium (upper poles of both testicles);

LO4-2000 laser radiation probes (output radiation power 7–10 W) and KLO3-2000 (maximum output radiation power) with ZM50
        magnetic attachments (50 mT) on projection of the lower half of marsupium (lower poles of both testicles).

The position of probes in red and infrared spectra alternates every other day.

Fig. 15. Magneto-laser therapy technique of AE in stage III (fine-focal suppurative-destructive),

1st session

Location of radiation probes in the 2nd session as shown in Fig. 16:

MLO1K-2000 matrix radiation probe, power 50–60 W horizontally on projection of one testicle;

MLO1K-2000 matrix radiation probe, power 50–60 W vertically on projection of other testicle.

Position of the patient – lying flat on back, on treatment couch, with legs spread.

If the therapy conducted is not effective, surgical treatment is required.

Fig. 16. Magneto-laser therapy technique of AE in stage III (fine-focal suppurative-destructive),

2nd session

11. Incisions

Laser therapy is an effective technique of treatment of patients, who underwent various operative interventions, repair and reconstructive operations on ureter, operations for ureter- and vesicovaginal fistulas, plastic operations for enuresis. Application of the technique makes it possible to reduce the time of regenerative processes, to reduce the likelihood of complications occurrence.

LT technique: stationary, distant. Treatment sessions are conducted the day before the operation and in 2–3 days after. LO4-2000 radiation probe, pulse radiation power 7–10 W or MLO1K-2000, pulse radiation power 40–50 W (Mustang 2000 or Mustang 2000+ laser therapeutic device), frequency 80 Hz. Action within the area of an incision in 2-3 zones within 0.5–1 min. per zone. The course may be repeated in 4-5 days if necessary.

12. Prostatitis

Inflammatory affections of prostate gland, seminal vesicles, seminal hillock (prostatitis, vesiculitis, colliculitis) are the most common diseases of the genitourinary sphere of men taking often a chronic course. The prostatitis is subdivided into bacterial and abacterial. This classification approach will be important for selection of one or another treatment technique. In case of bacterial prostatitis, a banal or nonspecific flora is detected in secretion of prostate gland. In case of abacterial prostatitis, intracellular activators (STD) whether can be detected in the secretion of the prostate gland and in the scrape from urethra, or they can be not present therein.

The mechanism of disease progression is rather complicated. Most often, several factors should be present simultaneously: anatomic and functional disturbances in prostate (as a consequence of acute prostatitis suffered earlier or an attach of chronic prostatitis with cicatrical-sclerotic outcome), venal and lymphatic stasis within the pelvic organs, immunodifficient conditions (of both, local and general genesis), the presence of an infectious agent of various aetiology, disorders in the part of urination (ureter-prostatic reflux), sex life rhythm disorders etc.

The following presentations come to the foreground in clinical progression of the prostatitis:  dusyric and pain syndromes, sexual frustrations, reproductive changes and psychoneurological syndromes. Therefore, the prostatitis is not only a medical, but also a social problem in view of age of the patients and prevalence of the disease.

The prostatitis has got a status of a separate disease entity more than 100 years ago. An advanced chronic inflammatory process in mans genitals, as a general rule, is widespread, but a driving or main abnormal focus is located in one organ only.

Congenital pathogenetic or contributory causes of pathology development in the prostate gland include the following:

1) anatomic and physiological features of the prostate gland: crypto shaped mucous coat of excretory ducts of acini-glandules; it causes hindered outflow of its secretion due to changes in viscosity and pH value, on one hand, and due to compression of excretory ducts by oedema, on the other hand, hampers the effectiveness  of medication;

2) congenital absence of compressors, muscles bracing and compressing  the excretory duct openings, prostate gland lobes which are opened on the rear wall of posterior urethra (contributes to introduction of infection due to retrogradely occurring urethra-prostatic reflux);

3) disturbance of arterial blood supply to the prostate gland promoting tissue hypoxia occurrence; in the course of a treatment it hampers the possibility of adequate transportation of antimicrobial and antiviral medications to the target organ;

4) abundance of anastomoses among the prostate gland venae and pelvis low tension circulation contributes to spreading of pelvic congestions (congestive occurrences) into this organ that has an adverse effect not only on the run of the inflammatory process, but also on copulative and reproductive sexual functions (as well as arterial blood supply insufficiency);

5) anatomical vicinity of sex accessory organs (prostate gland, seminal vesicles, seminal hillock) causes a mutual ingress of infection that gives grounds for application of therapy by physical factors with the whole set of diseases of genitourinary sphere, including posterior urethritis, in mind;

6) anatomical vicinity of rectum causes the lymphogenic infection contamination of the prostate tissue with underlying congestion and disturbed arterial blood flow into the prostate gland tissues.

Among the acquired pathogenetic factors the immunologic one deserves special attention.

The pre-existing factors can be classified into the following basic groups in order of significance:

1) causing the development of congestion (stasis) in the small pelvis organs;

2) potential pockets of infection;

3) depressing the testosterone metabolism and causing the androgen deficiency;

4) promoting vegeto-neurotic disorders in the pelvis organs;

5) weakening general and local immunological responses.

The mechanism of action of contributory causes may be two-way. In some cases, the protective responses in the prostate gland are weakened (congestion in the pelvis organs, androgen deficiency, vegeto-neurotic disorders, changes in acid-base potential toward alkaline side, weakening of general and local responsiveness), in other cases, the potential disturbing factors (genital-pelvic) and extragenital pockets of infection and metabolic correlative factors are brought to the forefront. The potential disturbing factors include obligate (infectious agents) and facultative (immune alterations, androgenic disturbances, vegetovascular changes).

The secretion of prostate gland has antibacterial properties. Weakening or loss of these properties can be caused by: androgen deficiency of testicles due to acquired diseases or congestive effects; change in the secretion pH values. Account must be taken of functional condition of the accessory sexual glands. Particularly, acid-base potential is of great importance.

Disorders of pelvic blood circulation promote the development of inflammatory process in the prostate gland. Because the powerful parasympathetic ganglia and abundant network of sympathetic receptors are located in the prostate gland and within the pelvic area, the disorders of the vegetal nervous system conditions can be their cause (primary, etiological) rather than the consequence of organic changes in the prostate gland (secondary, pathogenetic). In the first case, the therapy should be started with repair of VNS disorders, and in the second case, the prostatitis should be treated in due time. VNS disorders disappear with resolution of infection in the prostate gland.

In case of any chronic intoxications (tabaccoism, alcoholism etc.), pancreatic diabetes, trauma, exposure of ionizing irradiation, nervous-vegetal, vascular and immune disorders as a result of their long-term indirect  action on the prostate gland, disruption of trophism, vegetal innervations, and immune responsiveness of the gland occurs. Occurring thereby the destructive degenerative-trophic changes promote the conversion of non-pathogenic and potentially pathogenic flora into pathogenic (the quantitative factor has a paramount importance) causing the occurrence of an inflammatory process. Resulting from a wide and, over all, uncontrolled application of strong antimicrobial medications the potentially pathogenic flora penetrating deeply into the organs of urogenital system causes a chronic inflammatory process. Fungus diseases are thereat of frequent occurrence.

Spread of pathogenic flora from remote organs (tonsillitis, caries, influenza, respiratory diseases etc.) occurs by hematogenic way in 3–12% of the cases. Lymphogenic spread of infection into the prostate gland is observed if any inflammatory focus is present in neighbouring and subjacent organs (rectum, urinary bladder, bulbourethral glands, testis, and seminal vesicles) in 8–17% of the cases. According to different authors, urethral or canalicular way of infection contamination composes 75–100%. According to I.F. Yund (1981), urethritis and urethral way of infection contamination is possible as a result of action of the preceding factors which cause dysbacteriosis, weakening of inter-organ protective mechanisms and subsequent introduction of infection.

The degree of a pathologic process spread depends on the disease remoteness and way of the infection contamination. In case of hematogenic and lymphogenic ingress of infection the inflammatory process is often acute and localized. Urethrogenic and canalicular contamination of infection results, as a general rule, in involvement of a number of organs, the inflammation presents less acutely. Both variants of the inflammation course are united by commonness of the preceding factors. The success of therapy depends largely on their timely repair.

Clinic-bacteriological examinations of the patients with inflammatory diseases of male genital organs (orchitis, epididymitis, epididymo-orchitis, funiculitis, vesiculitis, prostatitis, colliculitis, posterior urethritis, balanitis, balanoposthitis) with the use of a separate single-step getting of excretes of genital organs  (secretion of prostate gland, secretion of seminal vesicles, ejaculate, urine) gave interesting results: non-identical microscopic flora was found in 34.5% of the patients. This goes to prove that the inflammatory diseases of genital organs of the same patient may be caused by both, common and different causative agents that is important to take into account when prescribing the medicaments.

In case of latent prostatitis, the inflammatory focuses are located usually near the urethral tract. Microscopically, the gland is not changed, though the inflammatory elements may be found in its secretion. In case of calculary prostatitis, there is a salt (cup calcic) incrustation with sporadic or multiple infiltrates, scars and closed suppurative cavities. An intense exfoliating of glandular and transitional cellular elements is typical for chronic nonspecific prostatitis along with the discharge of inflammatory exudate.

In 89% of the patients the prostatitis is accompanied by significant changes in seminal hillock and posterior urethra. Systematic examination of the specified sections of urethral tract is of great importance for diagnostics and treatment. Timely medical treatment of urethritis and colliculitis is the primary prerequisite of successful treatment and prevention of prostatitis.

The subjective and objective symptoms and signs of prostatitis are notable for high variability and polymorphism. At the same time, a common pattern can be observed in clinical presentations of the prostatitis. To detect these presentations and to control the patients conditions the ChronicProstatitisSymptom Index is used. It makes it possible to assess pain and dysuric syndromes, as well as the quality of the patients living.

The subjective data, such as pain, sense of discomfort in the region of anus, perineum, pelvic-lumbar region accompanied by vegetal, copulative or generative disorders are typical for all forms of the prostatitis. This picture is supplemented by particular signs.

General symptoms: rigor, temperature rise, general weakness, rapid fatigability, sleep disturbance, excessive nervousness, and obsessions.

Local symptoms: prostatalgia, change in shape, size and consistency of the prostate gland, high leukocyte reaction of the prostate gland secretion, extragenital pain, pelvic sympathalgia, heaviness below waist, itching (urethra, perineum, anus), paresthesias in genital organs (tickling feeling in the urethra, creeping sensation, coldness of genital organs etc.), pathologic discharges from urethra, more frequent desires to urinate, interrupted urine stream, changes in seminal hillock, posterior urethra, changes in seminal vesicles, rectum pathology.

Functional symptoms: intensification of spontaneous erections with underlying normal adequate erections, intensification of adequate erections, weakening of adequate erections, acceleration of ejaculation, inapparent orgasm, painful orgasm, sexual frustration, no impregnation, changes in quantity of ejaculate, pathospermia, primary sterility, secondary sterility.

Causative factors (infectious, hormone disruptions, immunologic, neurologic alterations) are assessed individually. They are of great significance in the patient treatment. When developing a treatment and prevention plan, any contributory causes should be eliminated in the first instance.

Fife main tasks are settled in the pathogenetic therapy which should be conducted simultaneously with etiotropic one:

1) general and local immunocorrection;

2) normalization of venal and arterial components of blood supply to the prostate gland;

3) reconstitution of secretion outflow of the prostate gland and seminal vesicles, Littre and Kuperovyhs glands by means of muscles hypertension of pelvis, perineum, smooth muscle fibres of the prostate gland;

4) regeneration of structural and morphological elements of pathologically modified tissues;

5) normalization of the complete range of functions of the organs affected.

These tasks are successfully settled by a complex therapy with the use of low-level laser irradiation.

Treatment of the patients suffering from nonspecific inflammatory diseases of the prostate gland, seminal vesicles, seminal hillock (prostatitis, vesiculitis, and colliculitis) should be comprehensive and ethiopathogetetic. However, many nonsurgical therapy techniques do not give the desired effect. The situation is turning to better when the therapeutic complex includes the exposure to ILBI of different spectral bands.

MLT mode, which includes a transrectoral action, when the action is exerted directly on the prostate gland and neurovascular bundle, exercising control of the organs function, in combination with transcutaneous blood irradiation in the biocontrol mode that makes it possible to make an immunocorrective action on the organism (BIO mode in Mustang 2000 or Mustang 2000+ laser therapeutic device), appeared to be the most efficient.

Drug-free methods are often not only an alternative for the conventional medicinal ones, but have also significant advantages as methods of functional regulation. At the same time, an efficiency of combination of various physiotherapy methods in combination with antibiotic treatment is demonstrated. For instance, I.V. Karpukhin et al. (2000) recommend to include in a multimodality therapy of prostatitis the LT, magnetic therapy and phonophoresis of medicaments by means of low-frequency ultrasound.

An interaction between the target organs and testosterone metabolism organs is complicated and poorly known. It is proved only that the liver is a source of hyperstrogenism, which causes the significant reproductive and copulative dysfunctions. Chronic latently running diseases of liver should be timely treated. Impairment of detoxification function of liver results in testosterone metabolic misbalance. Therefore, an action on the liver in the laser treatment mode takes one of the first places.

Owing to the multicomponent and multilevel action of ILBI, normalization of metabolism and blood circulation, a multimodality therapy of urological diseases with the use of laser irradiation is accompanied with improvement of the effectiveness of all therapeutic interventions. Definite improvement of lymph and blood flows in the region of laser exposure determines more effective entrance of antibiotic substances into the prostate gland that makes it possible to reduce the quantity of the required medicinal agents and the dosage of the medicines used.

The primary task of laser therapy is to select the exposure parameters, technique and modality, which ensure the maximum therapeutic effect in the absence of adverse effects. In case of excessive increase of content of endogenic photosensitizers (in particular, bilirubin) or overdosage of photo action, inhibition of phagocytic activity or excess NO products is possible that may aggravate the run of the basic disease.

Indications to laser therapy application:

• chronic congestive prostatitis;

• chronic bacterial prostatitis;

• chronic prostatitis at urogenital infection after the second course of anti-infective therapy;

• copulative dysfunction;

• inter-receptive male sterility caused by prostatitis;

• neurovegetative prostatopathy;

• prostatitis with prostatic hypertrophy in the absence of prostate carcinoma;

• urethral stricture.

The laser therapy is an additional aid in sub-acute and chronic periods of a disease contributing to sanitation of the affected area and mobilizing the body defences. Achievement of high remedial result, reduction of treatment period, improvement of drug bioavailability for the prostate can be provided by observance of simple organizational and therapeutic conditions. They include: reasonable diet, individual work-rest rhythm, remedial gymnastics, compliance with the rules for sex life hygiene, normalization of functions of the organs which participate in hormonopoiesis, sedative medicaments if any psychoneurological symptoms, elimination of potential infection pockets.

The laser therapy is conducted with partially filled urinary bladder (for subsequent mechanical evacuation of the prostate gland secretion with urine). The patient shall stay in an urogynecological examination chair, lying flat on back that enables him to relax maximally its skeletal muscles of the lower part of the body and lower limbs. Action by laser radiation is intra-rectal (Fig. 17) and/or transcutaneous on perineum (a region between marsupium and anus) through one layer of gauze wipe (Fig. 18).

Fig. 17. Intra-rectal laser therapy of prostatitis

Technique 1: intra-rectal, using Mustang 2000 or Mustang 2000+ laser therapeutic device. KLO3-2000 radiation probe, radiation wavelength 0.63 m, maximum output radiation power, within 1.5–2 minutes through a proctologic attachment of P-2 type (Fig. 19) entered into rectum, on the prostate gland projection (Fig. 17). It makes it possible to eliminate the inflammatory processes in the gland, as well as to improve the blood flow in the tissues within the exposure region. Such technique is recommended for use in the first several sessions, especially in case of advanced form of chronic prostatitis, as well as in the course of antibacterial therapy.

Fig. 18. Transcutaneous laser therapy of prostatitis

Fig. 19. P-2 proctologic attachment

Technique 2: transcutaneous, using Mustang 2000 or Mustang 2000+ laser therapeutic device. Radiation of pulse infrared lasers, wavelength 0.89 m, pulse recurrence frequency 80 Hz, output radiation power 7–10 W for LO4-2000 radiation probe and 40–50 W for MLO1K-2000 matrix radiation probe, time of exposure 1.5–2 min. transcutaneously (Fig. 18). Intra-rectal technique is also allowed for LO4-2000 radiation probe with P-2 proctologic attachment (see above).

Technique 3: BIO mode using Mustang 2000 or Mustang 2000+ laser therapeutic device. In this mode, phase coincidence of small pelvis and perineum simulation (exposure techniques 1 and 2) with pulse wave phase and 10 Hz modulation frequency is an additional factor improving the functions of microcirculatory bloodstream which is the most affected by pathological changes. Such mode is recommended for use in the final three sessions of laser therapy for normalization of the prostate gland and central (system) regulatory mechanisms functioning. Pulse recurrence frequency 3000 Hz for pulse laser probes, time of exposure is increased to 5 min. 

Technique 4: acupunctural, using Mustang 2000 or Mustang 2000+ laser therapeutic device. The possibility to conduct the laserpuncture by means of continuous or modulated radiation of the red spectral band (0.63 m, radiation power at the A-3 acupunctural attachment output (Fig. 20) 1–2 mW) on acupunctural points (AP) makes it possible to enhance the effects of the local laser action and provides mobilization of sanogenesis system mechanisms, makes it possible to rehabilitate the sexual function of the middle- and old age patients [Belavin A.S., 1991; Veinberg Z.S. et al., 1979; Kulavskyi V.A., Kryukov L.A., 1989].

Fig. 20. A-3 acupunctural attachment

Laserpuncture on basic prescription points is conducted immediately after the laser physiotherapy (exposure techniques 1 and 2) in the following order [Builin V.A., 1997, 2002]. The laserpuncture shall be conducted by a reflexologist.

On Monday, Wednesday, and Friday – action on points GI-4 and E-36 symmetrically, then on point VC-12.

On Tuesday and Thursday (Saturday) – action on points -6 and RP-6 symmetrically, then on point VC-12.

Exposition of corporeal AP is 10–20 sec. (not more than 30 sec). In case of laser radiation modulation by frequencies 1...10 Hz restorative effect is achieved mainly (exposure of one AP is 10 sec.), and by frequencies of 20...100 Hz – sedative (exposure 20–30 sec.). The optimum frequency of the laser radiation modulation is 2.4 Hz (frequencies 1...5 Hz – is a range of physiological rhythm of the prostate gland functioning).

It is showed by the experiments that the frequency of 1.2 Hz have a selective effect on cross-striated muscles of small pelvis and perineum. The frequency of 5 Hz is optimum for action on the smooth-muscle elements of the prostate gland, urinary bladder and straight intestine. The frequency of 21 Hz promotes the improvement of the trophism of nerve endings, restoration of their sensitiveness and conductibility.

At the laserpuncture the reflexologist may add to the basic prescription 2–3 points (depending on specific symptoms).

Prostatitis, vesiculitis, colliculitis: V-40, VC-1, VG-1, F-8, F-3.

Asthenic neuroticisms, psychogenic sexual dysfunctions: R-2, VG-4 (2.4 Hz modulation).

Plan of the laser therapy of chronic prostatitis without pronounced symptoms and gross structural and morphological changes in the prostate gland. This plan can be implemented for conduct of a preventive course of the prostatitis treatment. There are used LO4-2000 radiation probe, radiation power 7–10 W, frequency 80 Hz, with ZM50 magnetic attachment (50 mT) and MLO1K-2000 radiation probe, pulse radiation power 40–60 W, frequency 80 Hz, with MM50 magnetic attachment (50 mT). The patient shall stay in seated or prone position. Action on zones (Fig. 21) is made simultaneously by two radiation probes in the following order:

LO4-2000 radiation probe – zone 5 on one side of the body during 2 min., MLO1K-2000 radiation probe – zone 4 during 2 min.;

LO4-2000 radiation probe – zone 5 on another side of the body during 2 min., MLO1K-2000 radiation probe – zone 1 during 2

The patient lies on hisside and moves his kneels to the belly, MLO1K-2000 radiation probe is placed in the perineum (between anus and marsupium root), exposure is provided through 1–2 layers of gauze wipe during 2 min. Simultaneously, zone 2 is exposed to action of LO4-2000 radiation probe during 1 min., then zone 3 during 1 min. Upon completion of the session the patient shall rest for 15-20 min. sitting.

Fig. 21. Exposure zones in laser therapy of disease of male urogenital system organs

From the 4th session it is reasonable to add laserpuncture of basic prescription points (2.4 Hz modulation).

The course of laser therapy consists of 12 daily sessions (except for the weekend), it is reasonable to start the treatment on Monday.

In treatment of advanced stages of the prostatitis forms with pronounced symptoms and objective changes in the gland the following plan of the laser therapy is implemented.

Sessions 15. The patient is in examination chair; KLO3-2000 radiation probe (7–10 mW, 5 Hz modulation frequency); straight intestine is exposed by means of P-2 proctologic attachment (a condom shall be put on the attachment) during 4–5 min. Simultaneously, by MLO1K-2000 radiation probe (power 40–60 W, frequency 80 Hz) with MM50 magnetic attachment one acts stationary on zones 4 and 1 (Fig. 21) by contact with exposure time of 2 min. on each.

Upon completion of each session, the patient makes breathing exercises staying in the examination chair. The patients breathing pattern during exercises is diaphragmatic; it means that the anterior abdominal wall shall pulled out as he inhales, and pulled in as he exhales. The perineum and pelvic floor muscles relaxation and tensioning controlled by the patient shall coincide with the breathing patterns (as he inhales – tensioning, as he exhales – relaxation). During these exercises, red ILBI (KLO3-2000 radiation probe, power 7–10 mW, modulation 5 Hz, -3 acupunctural attachment) acts on acupuncture point VC-1 (perineum, the point is located in the centre of the centre line connecting the marsupium root and anus) during 2 min. Thereafter, the patient is recommended to relive himself, and then to have rest during 15–20 minutes.

Sessions 6 to 9 inclusive: LO4-2000 radiation probes are used (7–10 W, 80 Hz, ZM50 magnetic attachment) and MLO1K-2000 (40–50 W, 80 Hz, MM50 magnetic attachment). The patient is in sitting position or lying. Action on zones (Fig. 21) is made simultaneously with these two radiation probes in the following order:

LO4-2000 radiation probe – zone 5 on one side of the body during 2 min, MLO1K-2000 radiation probe – zone 4 during 2 min.;

LO4-2000 radiation probe – zone 5 on other side of the body during 2 min, MLO1K-2000 radiation probe – zone 1 during 2 min.

The patient stands in the knee-elbow position; MLO1K-2000 radiation probe is placed in the perineum (between the anus and marsupium root), exposure is provided through 1–2 layers of gauze wipe during 2 min. Simultaneously, LO4-2000 radiation probe acts on zone 2 during 1 min., then on zone 3 during 1 min. After completion of the session the patient shall have rest for 15–20 min. in the sitting position.

Sessions 1012. Biosynchronized magneto-laser therapy is conducted. The heart rate and respiration sensors are fixed on the patient (in the sitting position). Timer on the device panel is set on 10 min. (laser action on different zones shall be made continuously during 10 min.). The radiation probes are moved within the zones without switching off of ILBI so that the patient and doctors eyes were not exposed to the radiation (the radiation probe is moved above the body surface at the distance of 0.5-1 cm; exposure is controlled by the device timer like by stop watch). Action on zones (Fig. 21) is made simultaneously by these two radiation probes in the following order:

LO4-2000 radiation probe (80 Hz, 7–10 W, ZM50 magnetic attachment) – zone 5 on one side of the body during 2 min,
        MLO1K-2000 radiation probe (80 Hz, 40–50 W,
MM50 magnetic attachment) – zone 4 during 2 min;

LO4-2000 radiation probe – zone 5 on other side of the body during 2 min, MLO1K-2000 radiation probe – zone 1 during 2 min.

The patient lies on his side and moves his knees to the belly (thereafter one should check if the heart rate and respiration sensors are fixed securely). MLO1K-2000 radiation probe is placed in the perineum (between anus and marsupium root), exposure is provided through 1–2 layers of gauze wipe during 4-5 min. Simultaneously, one acts by LO4-2000 radiation probe on zone 2 during 2 min., then on zone 3 during 2 min. After completion of the session the patient shall have rest for 15–20 min. in the sitting position.

Unsatisfactory or negative result of LT is largely due wrong selection of dosages of laser and magneto-laser exposure, disregard of psychosomatic condition of the patient and importance of establishment of a good contact of doctor with patient.

If the conditions of the posterior urethritis and colliculitis prevail, as well as the dysfunction of ejaculation is pronounced, on conducts a transcutaneous, contact-mirror exposure (LO4-2000 laser probe, output radiation power 7–10 W, frequency 600 Hz) of the upper part of penis in its rear third and of its root during 5 min. on a zone. If MLO1K-2000 pulse IR-laser probe is used – power - maximum, frequency 600 Hz, exposure time also 5 min. for each zone. In addition KLO3-2000 laser probe of red spectrum (0.63 m) may be used with U-1 urethral attachment (Fig. 22) during 2 min.

Fig. 22. U-1 urethral attachment

V.I. Redkovich (1993) recommends to apply LT more widely for the patients with chronic prostatitis complicated by sterility due to high viscosity of ejaculate, reduction of mobility and activity of erythrocytes because ILBI improves the copulative and reproductive functions of such patients considerably.

The effect of laser and magnet-laser therapy of the said forms of prostatitis and their complications is achieved already by the end of the first course of treatment and confirmed by the patients subjective value and clinical laboratory studies.

13. Male Sexual Disorders

Erectile dysfunction (ED), a constant or temporary inability to get or keep erection sufficient for making successful coitus, is an important social and medical issue all over the world.

Inability to get erection or keep it is the most frequent failure which can trouble a man. The word impotency took not only an offensive connotation, but represents hardly anything of a complicated process of sexual dysfunction presentations.

There are two kinds of male sex disorders: reproductive failure and inability to perform coitus.

The following ED classification is recommended by the International Society of Impotence Research [Lizza E.F., Rosen R.C., 1999].

I. Psychogenic ED.

II. Organic ED:

1. Vasculogenic:

a) Arteriogenic;

b) Vein occlusive (cavernous);

c) Mixed.

2. Neurogenic.

3. Anatomic (structural).

4. Endocrine.

Dug induced ED, which is connected with administration of various pharmacological agents, is distinguished as a separate form of ED.

Until the early 1980s of the past century, ED was considered largely as a psychogenic disease, but with the development of diagnostic techniques organic causes of ED began to be detected in about 80% of the patients [Melman A., 1995].

At present, the relationship between ED and metabolic syndrome (MS), which is understood to be a combination of several vascular risk factors, first of all, impaired glucose tolerance, abdominal obesity, dyslipidaemia, and arterial hypertension (AH),  attracts special attention of the researches [Mazo E.B. et al., 2004, 2006].

It is noted that both, psychogenic forms of disorders and pseudo-impotency in young men, and loss of status in the sphere of importance in connection with the age-related reduction in sexual abilities, change in usual type of sexual relations, result in formation of persistent neurotic reactions with a decrease of interest in life. Currently, the most common sexual disorders in men are erection disorders, premature and retarded ejaculation.

There are two kinds of male sex disorders: reproductive failure and inability to perform coitus.

Sexual drive and sex satisfaction in men are based on erection, ejaculation, orgasm and libido. Control of erection and ejaculation as the complex reflex acts is performed at the level of VNS. While being interrelated at normal sexual function, they can be subjected to painful changes separately.

Male sexual potential is determined by general psychophysical state which is maintained at the proper level by sufficient physical activity and psychical equation technique. Strengthening regularly the ligaments and joints and training major muscles involved in sexual act, a man is able to increase their strength, endurance and flexibility that ultimately will have a positive impact on the end result. Moreover, any physical exercises activate the hormonal systems that result in increase of epinephrine, endorphins and testosterone contents in blood without which necessary amount the normal erection is impossible in general.

It is known that in case of regular sexual relations, the hormones such as epinephrine and cortisone, which stipulate the blood circulation, cerebration and prevent blind headaches, provides an opportunity to maintain an excellent psychophysical status, are generated in the organism. A love intercourse burns about 150 calories, i.e. it substitutes 30-minute jogging. Moreover, the heart rate quickens up to 160 beats per minute for a short time, and blood pressure is doubled for a while that is extremely useful for training of the heart-vascular system. The content of oxytocin, a hormone which relieves depression and loneliness, increases by 3.5 times in the climaxed organism. Other hormone, epinephrine, suppresses pain like morphine but without destroying consequences for the organism. One more hormone, cortisol (hydrocortisone) is required for people suffering from arthritis. According to the American scientists, the capacity to work falls down drastically in 70% of women and 25% of men if they experience sexual problems. The same cause gives rise to 60 to 100% neurosis.

The genital sphere of any human as an important element of maintenance of physiologic equilibration is included in the net of endocrine and vegetative systems that provides fine regulation of all systems and organs; moreover, these links are double-way. As it well-known, the small pelvic organs have strongly developed vegetative (sympathetic and parasympathetic) innervation.

The following diseases are attributed to the psychosomatic diseases of genital sphere:

• impotency;

• premature ejaculation;

• male sterility.

Any stress and emotional tension reduce considerably the organism resistance (in this context, any disease may be considered to be psychologically associated). If a failure in the work of brain cortical divisions, VNS or endocrine system occurs caused by frequent and long-term psychoemotional over-tensions, infections, intoxications, traumas etc. (diagnosed to be neurosis, vegetative dystonia, hyper- or hypothyrosis etc.), it results in dyscrasia (flowing equilibrium of internal environment) and development of various syndromes of the secondary affection of organs, tissues. There is also a feedback: pathogenetic role of somatic pathology in the development of neuropsychic disorders.

Large number of patients suffer from psychogenic impotency with pathologic over-excitation of ejaculation function and pathologic inhibition of erection function. The impotency forms with over-excitation are developed more frequently in the patients with neurasthenic and hysteric neurosis, with inhibition – in patients with obsessive-compulsive neurosis.

The impotency sends signals on the following troubles:

• neurotic disorders, depressions (in 75–90% of the cases);

• pancreatic diabetes;

• alcohol dependence, narcomania, organism intoxication;

• metabolic disturbance (up to 10%).

In the event of these diseases, blood supply to various organs, pulse transmission via sensigerous and motor fibres are disturbed, which means that the reflex arc that ensures the erection suffers, too. The problems with sexual potency occur sometimes after traumas or diseases of spinal cord and brain. Often, disturbed erection is the first symptom of an infectious affection, trauma, tumour, epilepsy or Parkinsons disease. The impotency can be developed as a bad effect of drug administration. Any counter-depressants, neuroleptic agents, antianxiety agents, agents for hypertension treatment, and agents, which reduce the gastric secretion, have an impact on erection. Analgin, antihypertensive drugs, smoking and alcohol reduce sexual drive; suppress erection and retard ejaculation. The content of testosterone in blood decreases with age in certain diseases.

There is a term in the world sexual medicine businessman syndrome, which means decrease of sexual activity in the absence of any diseases. This syndrome means the development of stagnations in the small pelvis due to improper sedentary lifestyle and high psychological stresses, excessive smoking, misbalanced nutrition. Due to smoking, in 8 cases out of 10, vasoconstriction occurs in male genitals, and as a result – impotency. The smokers have 2 times more chances to become a sexual impotent than the non-smokers (up to 50% of the examined smokers suffer from sexual impotency to a greater or lesser degree). In accordance with the results of a research, it was noted the absence of sex drive (libido) in more than 56% and reduction of sexual potency – in 46% in a group of men having being involved in business for 5–8 years.

The maximum time limit for a male drinker is 15 years. If he took his first glass of port wine when he was 15-16 years old, he has very seriously to give thought to the fact how long he will remain a man. The man does not want to admit to himself that the reduced sexual potency is caused by allocation of alcohol andhe goes to an urologist. The latter, having found nothing special and having not analysed the situation well and being afraid to admit it, makes a diagnosis of chronic prostatitis. The patient is being treated, but his sexual function is never normalized. The drinkers find fault mainly with detumesco (sudden disappearance of erection during the sexual congress). The treatment is possible provided of unconditional refusal of alcohol for a long term.

Deficiency of testosterone is found in every fifth man with age. As a rule, the symptoms of testosterone deficiency are not given enough attention resulting in serious problems with health, including osteoporosis and depression. An early diagnostics is required first and foremost. As a general rule, special attention should be paid to the elderly men with the symptoms of hypodynamia, problems with erection, loss of energy and interest in sex (libido), depression and mood swings, problems with attention concentration, decrease of muscle bulk and hair covering on breast and troubled sleep.

It is important to exclude causes such as pituitary tumour and damage to the testicles. Decreased testosterone level in boys and adolescents may have a genetic condition. Along with the blood tests, the level of other hormones, the condition of the pituitary gland and bones are diagnosed, the analysis of seminal fluid is made and the prostate gland is examined.

Sexual dysfunction in man includes disturbances of libido (sex drive), penile erection (erectile dysfunction, ED) and ejaculation (emission of seminal fluid), but not necessarily all they are observed in one patient. In particular, those erectile dysfunctions occur most often, for which treatment the most intensive and effective arsenal of medical and surgical aids is proposed. It should be noted that the above list of sexual function disorders is called sometimes sexual dysfunction. However, in endocrinologic practice the term of sexual dysfunction includes a wider range of issues, in particular, disturbance of genital glands hormone regulations, their influence on the processes of puberty, metabolic processes, and others. Therefore, it is reasonably to define the disturbance of sexual relations as sexual dysfunction considering it as one of the aspects of manifestation of endocrine sexual dysfunction if it occurred, for example, in connection with hypogenitalism.

Among the men with diabetes, ED occurs in 50-70% of the cases, and occurs at a younger age (within the first 10 years of illness) than in the population as a whole. Among people with diabetes aged 20-29 years it occurs in 9% and increases to 95% at age of 70. It is noted that the ED may be the first sign of diabetes of the second type. ED may be an indirect sign of generalization of atherosclerotic vascular disease in diabetes and coronary heart disease progression harbinger.

Acetylcholine and some non-adrenergic, non-cholinergic messengers are neurotransmitters of nerve endings involved in the erectile response. The end neurotransmitter is an active vasodilator - nitric oxide (NO). The latter increases the level of cyclic guanosine monophosphate (cGMP) in smooth muscle cells of the penis which activates relaxation of smooth muscles of erectile tissues. This ultimately causes the erection, cGMP further is split in the erectile tissues under action of specific for cavernous body phosphodiesterase of the 5th type and detumesco (return to its original state after erection) occurs.

Peripheral nerves have sensory and motor elements, which constitute a part of the reflex arc closed in spinal cord in the region known as spinal erectile centre. Consequently, so-called "reflex" erection can be caused by direct stimulating effect on penis is not only in healthy people, but also in the patients with spinal cord suprasacral intersection.

At the present time, one can call main pathogenesis links of neurosomatic affections. Firstly, it is neurotrophic and neurovascular disorders. Secondly, an excessive or inadequate production of a hormone. All this results in significant alterations of homeostasis (disorders of protein, carbohydrate, fat, water electrolyte metabolism, acid-base balance, etc.) and disorders in metabolic processes in cells and tissues. The prominent Soviet pathophysiologist A.D. Speranski came to the conclusion that a nonspecific neurotrophic component is necessarily included in the pathogenesis of any disease process (infectious, traumatic, psychosomatic etc.). This was further confirmed by many experiments and clinical data.

Pathologic pulses reach a particular organ or several organs mainly via sympathetic nerves that results, in case of prolonged exposure, in depletion of tissue reserves of norepinephrine and development of local or diffuse dystrophies. The experimental studies are consistent with clinical observations which showed how neuroses and vegetative functional disorders can eventually culminate with an organic disease - resistant arterial hypertension, stomach ulcers, gangrene of limbs, myocardial dystrophy, etc. Any organ and tissue dystrophies are based on its reflex nature, i.e. unusual in strength and duration of stimulation. Sympathetic nerves are an effector way by reflexes disturbing trophism, and the immediate cause - the release of noradrenaline at the ends of the nerves in a very high concentration. Another pathogenic factor is a disorder of homeostasis (often relatively selective: in the heart, lungs, liver, muscles, skin, etc.) due to insufficient or excessive generation of hormones and mediators (ACTH, growth hormone, mineral and glucocorticoids, thyroxin, adrenaline etc.) [Krupin V.N., Serova S.V., 1992; Martynov Yu.S. et al., 1980].

The data accumulated at present indicate that the central link of pathogenesis of any neurosomatic disturbances is hypothalamic-pituitary. In case of an excessive nervous tension and conflicts the regulating effect of the brain on the lower levels of vegetative nervous system and the endocrine glands is disarranged. In some cases, the pathogenesis of the disease is caused by a relatively selective involvement of VNS, in other cases - by endocrine glands. A type of emotions (fear, anger, doubt, joy, etc.) has certain importance for the nature of psychosomatic diseases development; it determines a specificity of excitation of the regulatory systems, the acuteness of the process. Reflexologists know the connection of each kind of emotions with a specific organ (e.g., anger is connected with liver, it damages it). Unpleasant thoughts, heavy thoughts, doubts, remorse result in neurotrophic and neurovascular disorders and diseases.

The feedback is also proved: a pathogenetic role of somatic pathology in the development of neuropsychic disorders. A pathological pulsation with development of repercussive and generalized reflex syndromes (vegetovascular dystonia, neurasthenia, reflex paralysis, contracture, and hyperkinesis) can occur from an affected organ. Radicular and neurasthenic syndromes and vegetative endocrine disorders are often observed in the patients suffering from chronic inflammation of the prostate. General symptoms of prostatitis are nonspecific: it is general weakness, sleep and mood disturbances, fatigability, performance impairment, well-being variations during the day. But main symptom is a painful and difficult urination. The sexual dysfunctions are often the only complaint of the patient with prostatitis. Hormonal imbalance results in decrease of sexual desire, rare sexual congresses and, consequently, to stagnation in the prostate gland, which closes the "vicious circle" of the disease. Another complaint of the people suffering from prostatitis is sterility.

Treatment of functional and organic diseases of genital organs, as well as sexual dysfunction is a topical and complicated problem. Currently, there are used practically all kinds of local and systemic treatments of this pathology known in medicine. In case of neurogenic form of impotency, it is quite effective the use of a variety of physical factors, in particular, the magnetic field [Myasnikov I.G., Krupin V.I., 1992], galvanization, medicine electrophoresis, an electric field UHF, decimetre waves and sinusoidal modulated currents, mud, naftalan and clay applications [Karpukhin I.V., 1991; Karpukhin I.V. et al., 1991], acupuncture [Jingzhong W., 1989; Muccioli M., 1990]. The effectiveness of physiotherapy increases greatly against the medical treatment conducted concurrently. If there are any signs of failure of the sympathetic-adrenal system (adynamia, apathy, drowsiness, hypoglycaemia, and hypotension), then the inclusion of stimulants, including hormones, in the scope of therapeutic agents, can have a beneficial effect on the disease. On the contrary, if an excessive over-excitation of the system (insomnia, increased blood pressure, tachycardia, hyperglycaemia, hyperadrenia), it is the prescription of the agents of ganglioblocking and neuroleptic action that usually improves the condition of the patients and can prevent the development of dangerous complications associated with the depletion of catecholamines and acetylcholine in the nervous system and various organs and tissues

Organic causes of sexual dysfunctions need another approach and another treatment method. About 25% of the men, having had traumatic brain injury, suffer from sexual dysfunctions, 99% of the men with diseases and spinal injuries have affected erection function. Any hurts and injuries of penis make the sexual congress difficult or impossible at all. In 70% of the men the decrease of male fertility is caused by an infectious disease. Even the diseases such as influenza, pneumonia, otitis, can cause loss of erection in any man.

It should be noted that up to 30% of the men among the patients with erectile dysfunctions (ED) suffer from pancreatic diabetes and 40% - from vascular abnormalities (in total 70%), and diabetes is main cause of vascular affections. Other factors of ED are relatively rare, they include: hypothyroidism, hypogenitalism, adipose, smoking, disseminated sclerosis, chronic renal insufficiency, surgical or traumatic injuries of penis, prostate gland, urinary bladder, pelvis and spinal cord structures, alcohol impact, medications for treatment of arterial hypertension, antihistaminic medications, antidepressants, tranquilizers, anorectic agents and Cytimidine. The male fertility is reduced due to full and even partial starvation.

The treatment of the patients with sexual disorders should be complex subject to a close professional collaboration of doctors of different specialties: urologist, therapist, neurologist, psychotherapist, and sexologist. Modern operative and orthopaedic equipment is extremely effective in case of organic pathology of the sexual sphere.

The laser treatment of sexual disorders has significantly expended the therapeutic possibilities of modern sexologists and reflexologists. It is due to the fact that LLLT is sufficiently effective in case of organic sexual disorders caused by somatic pathology, and in case of secondary affections due to traumas or disease. Thanks to the systematic exposure to laser radiation, to the effect of energy swap the normalization of functioning of almost all systems of the organism occurs.

The control of erection and ejaculation as complex reflex acts occurs at the level of vegetative nervous system; therefore, their repair can be successfully resolved by methods of reflexotherapy [Ivanov V.I., 1991; Fomberstein K.B., 1991]. It is demonstrated high efficiency of combined and associated LT of various diseases of urogenital sphere and sexual disorders [Vozianov A.F. et al., 1990; Kovalenko V.V., Kovtunyak O.N., 1990; Kushniruk Yu.I. et al., 1988; Reznikov L.Ya. et al., 1988]. The modern techniques of combined exposure to optical (laser) and microwave (EHF) bands are promising [Brekhov E.I. et al., 2007].

Numerous studies and clinical practices have definitely proved the high efficiency of laser reflexotherapy in case of various pathology, including in the sexual sphere [Beleda R.V., Taktarov V.G., 2002; Builin V.A., 1998; Yasinki B.V., Zhyboryev B.N., 1988]. The laser stimulation of acupuncture zones enhances the immune resistance potential, nonspecific resistance of the organism, normalizes the regional and systemic neuroendocrinal and microvascular control. The laser reflexotherapy with the use of basic prescription of acupuncture points and combination of specific corporeal and auricular points, as well as local negative pressure (LNP) [Beleda R.V., Taktarov V.G., 2002; Kovalenko V.V., Kovtunyak O.N., 1990], makes is possible to eliminate or significantly reduce any neurasthenic, psychasthenic and depressive components of sexual disorders . A complex of yearly rehabilitation based on LNP technique with simultaneous exposure to red diodes improves the penile circulatory dynamics, increases oxygen saturation, mitigates the risk of local fibrosis of albugineous tunic preventing any secondary damage of venoocclusive mechanism occurring after remedial surgical procedures on  penis venous basins of the patients with vasculogenic form of  erectile dysfunctions [Yerkovich A.A., 2007].

Indications to apply LT [Laser Therapy of Sexual Disorders, 1997]:

• various clinical variants of damages of vascular component of copulatory interval erection component;

• psychogenic form of disorder of psychic component, particularly, in case of misfortune expectation neurosis;

• debut form of impotency;

• rapid ejaculation;

• chronic prostatitis and prostatevesiculitis, especially with underlying congestion in small pelvis;

• absistent forms of dispontecy;

• as an element of sexual rehabilitation complex of the patients after edenomectomy;

• Peyronies disease;

• copulative dysfunction in the patients operated for urethral stricture;

• potency disturbance after cavernitis;

• as a final (rehabilitation) stage after penis vascularization;

• as a final treatment stage of phalloplasty operation and in case of epi- and hypospadias, micropenis;

• intermittent priapism.

Contraindications to apply LT:


• any tumours (including prostate adenoma);

• hypertensive disease in stage III;

• pronounced arterial sclerosis of heart and brain;

• serious chronic disease of internals (glumeronephritis, pancreatitis, hepatitis etc.) in the exacerbation phase;

• serologic disorders caused by endogenetic processes.


• inguinal and inguinoscrotal hernias;

• pampinocele of the 2nd and 3rd degree;

• thrombophlebitis of pelvis and lower limb venaes;

• hydrocele and funicle membrane hydrocele;

• phimosis and paraphimosis;

• acute and chronic diseases of testicle and epididymis; acute inflammatory disease of genital organs;

• photodermatotis.

In case of any sexual disorders accompanied by inflammatory and degenerative processes in the prostate gland, the treatment begins with a local action on the affected areas (see section Prostatitis). After a 2-3 week break the laser reflexotherapy is carried out in accordance with the plans below. The parameters of laser stimulation of acupuncture points are referred to in section Prostatitis.

Composing a prescription, one adheres to the principles of Zhen-Chiu therapy. [Laser Therapy of Sexual Disorders, 1997]. A set of PA of general effect is distributed by weekdays in accordance with the canons of the modern acupuncture and recommendations of the modern chronomedicine. 4-6 points are used during one session. Ratio of corporeal and auricular PA is 2:1. One tries to select PA of general and local actions in approximate the same ratio. The laserpuncture sessions are carried out daily within the first half of day (it is well know that maximum generation of testosterone and minimum of antisexual hormone occurs in the man in the morning) during 10-12 days. If necessary, the course is repeated in a 2–3 week break. The basic prescription is supplemented with points  GI-11, -7, TR-5; among the local and segmental corporeal points the points V-23, V-31, V-32, V-33, V-34, F-5, -11, VC-2, VC-3 and VC-6 are the most frequently used. Auriculotherapy is carried out on -13 – adrenal gland point, -22 – glands of internal secretion point, -32 – testicle point, -56 – pelvis point and -58 – sexual point, -95 – kidney point, -79 – point of external sex organs.

In case of erectile insufficiency with normal ejaculation and retained libido the following plan of the laser reflexotherapy can be recommended:

1st day: -36, RP-6;

2nd day: -6, VG-2, -58;

3rd day: -7, VG-3, VG-4, -58, -79;

4th day: TR-5, V-31, V-32, -56, -95;

5th day: -36, V-31, V-32, V-33, -95;

6th day: GI-4, VG-3, VG-5, -22, -32;

7th day: -7, V-27, V-28, V-29, -22;

8th day: TR-5, V-27, V-28, -32;

9th day: -6, VC-2, VC-6, -79;

10th day: GI-4, R-11, VC-4, -13;

11th day: RP-3, RP-4, VC-3, -58;

12th day: -36, GI-11.

Action on symmetrical points is made on both sides of the body.

In case of normal erection and rapid ejaculation action on PA of basic prescription by low-frequency modulation (up to 20 Hz) is used. Additional action is provided on several local and segmental AP points: VG-3, V-28, V-25, V-31, V-32, V-33, V-34, R-10, R-13 R-11. Among the points on concha of auricle the most indicated for treatment are -22, -55, -58, -79 -93.

Approximate plan of AP selection for the laser reflexotherapy:

1st day: RP-6, -36;

2nd day: F-5, VC-2, -55;

3rd day: -6, VC-2, VG-4, -58, -79;

4th day: GI-4, V-31, V-32, -58, -32;

5th day: RP-6, V-31, V-33, -22;

6th day: -7, VG-4, VC-3, -55;

7th day: GI-4, VC-4, VC-5, -32;

8th day: F-6, RP-8, VC-7, -93;

9th day: F-5, -11;

10th day: RP-6, -36.

In case of misfortune expectation neurosis, erection disorders with underlying psychasthenia or depression of various degree of manifestation it is necessary to add the points R-7, R-3, R-10 and F-1. Auriculotherapy on points -22, -79, -95 -97. Action is made in accordance with the plan:

1st day: -36, GI-4, GI-11, VC-12;

2nd day: GI-4, RP-6, -55, VC-12;

3rd day: -6, V-23, -34;

4th day: -7, V-25, VG-4, -93;

5th day: F-2, F-4, -22, -95;

6th day: -36, -30, VG-3, -97, -58, VC-12;

7th day: R-9, R-12, VC-4, -23, -25;

8th day: VC-2, VC-3, VC-6, AP-113;

9th day: GI-11, -10, VB-31, -34;

10th day: -36, -6, -58, VC-12.

For treatment of the patients with spermatogenesis abnormalities, especially with underlying neurohumoral alterations present, the corporeal points are used: VG-4, VG-3, V-23, VC-1, VB-20, -7, VC-6, -7. Laserpuncture of these points results in a remarkable increase of luteinizing hormone of blood plasma and testosterone, and thus, particularly indicated if there is a need to increase the sperm motility in case of asthenozoospermia. In this case -16, -17, -32 -22 are used.

An important issue is the compatibility of reflexotherapy with basic drugs and physiotherapeutic procedures. The practice shows that in laserpuncture the vitamins, antibiotics, analgesics, adaptogens and immunomodulators may be used. It is unacceptable to take simultaneously any drug changing the vegetative tonus, vasoactive and psychotropic agents. After receiving antipsychotics, tranquilizers, antidepressants, steroids, vegetotropic medications at least 3 weeks should pass before you can start the laser reflexotherapy. According to the canons of classical Zhen-Chiu therapy, other physiotherapeutic treatments should not be carried out also. However, based on the clinical experience, we can recommend the simultaneous massage of the prostate and seminal vesicles, baromassage of segmental points on back and waist, exposure to local negative pressure (LNP) on the penis or carrying out of a dosed local hyperthermia of the prostate gland. Point massage in case of weakening of erection and ejaculation is made by stimulating method alternating with relieving massage, and in case of premature ejaculation (but normal erection) relieving method is used only [Tsutsumi I., 1984].

Upon completion of the first course of laser therapy a 3-week break should be done. Further treatment (the 2nd and 3rd courses, and then, in a 6-month break, the protracted treatment is repeated if necessary) is aimed at normalization of disturbed functions of various systems taking into account the specific symptoms and signs of each patient. Mainly, it is laser reflexotherapy, which can be combined with other methods of reflexotherapy (microneedles, application by medicinal substances, metals, hammer bone, acupressure etc.), but if the treatment of a related somatic pathology is required, laser physiotherapy is applied also in accordance with special techniques.

After 2–3 courses of physical- and reflexotherapy it is reasonable to carry out a course of the systemic energoinformational therapy – colour therapy. The method has been known for several millenniums and is used traditionally in India, China and other oriental countries. There are used light-emitting diode radiation probes of red SO3-2000, yellow SO4-2000, green SO5-2000 and blue SO6-2000 colours (Fig. 13) for Mustang 2000 or Mustang 2000+ device. The colour therapy is carried out in 2 weeks after completion of a laser therapy course. Action is made on exposed body areas, the surrounding areas are covered with clothes. After connection of the relevant light-emitting diode radiation probe to Mustang 2000 or Mustang 2000+ device, the radiation power is increased to the maximum value. The radiation probe is located at the distance of 1 cm far from the skin surface. Point zones are treated stationary. To treat large areas the light-emitting diode radiation probes of matrix type of red MSO3M-2000, yellow MSO4M-2000, green MSO5M-2000 and blue MSO6M-2000 colours (Fig. 23) are used.

Fig. 23. Appearance of light-emitting diode radiation probes of matrix type

I. View of display panel. II. View of window for radiation outlet.

The plan of colour therapy course is as follows:

1st session: action on perinea region with blue colour within 15 min. (a zone before anus), on omphalus – with green colour within 1 min.

2nd session: blue colour on perinea region – 20 min., green colour on omphalus within 2 min.

3rd and 4th sessions: yellow colour on heels (within 5 min. on each), on the point above symphysis (along median line) – 5 min., on sacral region and perineum before anus – within 10 min. each.

58th sessions: green colour on heels – 5 min. each, above pubis – 5 min, on perineum and sacral region –10 min. each, on omphalus – 1 min.

912th sessions: red colour on the region from LV to SIV – 15 min., yellow on the region of ThX–LI – 10 min., blue on vertex – 10 min.

The colour therapy under this plan contributes to effective treatment of prostatitis, stimulates the endocrine glands and potency, renal function, and recovers from depression.

The laser- and colour therapy can be repeated in 6 months if necessary.

14. Laser-vacuum therapy technique

The method of treatment of the patients with erectile dysfunction combining action with negative pressure and phototherapy is well-known [Builin V.A., 1998; Builin V.A. et al., 2004; Zelyenchuk A.V. et al., 2003; Laser Therapy of Sexual Disorders, 1997; Loran O.B. et al., 1998; Okovitov V.V., 2007; Shaplygin L.V. et al., 2004]. However, until recently, in all commercially available devices and complexes action by light-emitting diodes was used, i.e. there was applied the method of vacuum phototherapy. At the present time, a complex for laser-vacuum therapy of the patients with erectile dysfunction, the so-called method of local laser negative pressure (LLNP) or laser vacuum therapy (LVT) is applied in Russia.

V.I. Yakushev et al. (1989) included LLLT and the method of non-invasive blood irradiation, consisting of transcutaneous action on venous blood circulating in the cavernous bodies in large volumes in the course of the session of erectile disorder treatment by method of local negative pressure (LNP) for the patients suffering from disturbance of copulative function. For this purpose, the process vessel of the unit for LNP therapy was equipped with a laser source and a tank for immersion medium. O.K. Yatsenko (1996) showed in his study the efficiency of the companied action of ILBI and LNP.

Before to conduct the first session, any patient should:

• fill in the form International Index of Erectile Function;

• understand the meaning and technique in an intelligible form;

Special attention of the patient should be attracted to the available pressure regulating buttons and switch buttons on Mustang-VACUUM-DynaVac vacuum massage device (Fig. 24), having explained to him that he can reduce the vacuum intensity in the vacuum cup (or switch off the device at all) at any time (in case of discomfort).

Fig. 24. Mustang-VACUUM-DynaVac vacuum massage device

The patient is positioned on a couch or (better) seated on a chair. His penis is placed into the vacuum cup, the marsupium remains outside. The marsupium skin is pulled back and held by the patients hand so the first few minutes after the start of the session. It is important to achieve the best fit of the vacuum cup by applying sterile gel on its adjacent end. Also, it is recommended to apply the gel on the dorsal surface of the internal part of the cup, on which the urethral surface of the penis rests to prevent any injury of the cavernous bodies (due to torsion) and frenulum (friction against the internal surface of the vacuum cup) at the start of negative pressure. In some cases the patient is recommended to remove preliminary the hair within the area of use of the device.

The vacuum cup is connected to Mustang-VACUUM-DynaVac vacuum massage device by means of a connecting tube to create vacuum. The doctor sets the required parameters of the treatment procedure using the controls on the front panel and switches on the device. The value of negative pressure is set individually for each patient. The required parameters of laser-vacuum therapy are determined by trials. The practice shows that the initial weak erection occurs if the pressure is reduced to 15-20 kPa.

The first session should be started with pressure of 20 kPa, increase or reduce it gradually depending on the sensations of the patient. By completion of the first session, the negative pressure should be brought to not less than 25 kPa againt the habituation.

The combined LSO-TED laser-and-light emitting diode radiation probe (Fig. 25) is connected to two channels of Mustang 2000 or Mustang 2000+ device. This probe is completed with 8 IR-laser diodes of purse radiation mode with wavelength 0.89 m of 60 W total maximum power, and with 18 red diodes of continuous mode with wavelength of 0.63 m of 75 mW total maximum power. The laser diodes are located on the probe in such a way that provides the maximum efficient impact on the cavernous bodies. One connection cord of the probe connects IR-laser pulse diodes (channel 1), the other one – red diodes (channel 2).

Fig. 25. LSO-TED combined radiation probe (1) on vacuum cup (2)

In the course of the session the doctor and patient observe the status of penis through the transparent walls of the cup. Local reduction of atmospheric pressure in the vacuum cup wherein the penis is placed causes an intense affluxion of blood to the cavernous bodies causing passive erection of penis.

The treatment sessions are conducted under the visual supervision control and a verbal contact with the patient within the range of maximum reduction of pressure to 35–40 kPa. Even in the absence of unpleasant sensations in the region of balanus it is not reasonable to reduce the pressure by more than 40 kPa. The vacuum is maintained within up to 60 seconds at the required level of pressure release by 30–35–40 kPa, thereafter the pressure is smoothly increased within 10-15 seconds to initial one.

In case of the need of rapid (emergency) increase of pressure, when the patient feels pain in his penis balanus, the button of compressor shutdown should be pressed immediately. In the normal state of the patients health the vacuum exposure is repeated in 10-15 seconds of break. Nr. 12-15 cycles (ups and downs) are performed during one treatment session. The treatment course includes, on average, 12-15 (up to 20) sessions of laser-vacuum therapy. The first 8–10 sessions are conducted daily, the rest – with break of 1-2 days (on average, 3 times per week).

The laser radiation shall be performed as follows: if the companied LSO-TED radiation probe is used, switch on Mustang 2000 or Mustang 2000+ basic unit in sequence first the channel with red light-emitting diode radiation at the carrier frequency in biomodulated mode in accordance with the heart and respiration rates, and then the channel with the connected IR-laser pulse radiation. The above actions by each of the channels should be made during all cycles of pressure variation. The recommended total time of one session – 12 min. (by 6 min. for each type of radiation). During a session of laser-vacuum therapy the number of cycles and their duration should not be brought till occurrence of oedema of penis prepuce.

Criteria of positive dynamic of laser-vacuum therapy:

• pronounced lasting erection of penis already in the first cycles of changing pressure in the cup;

• spontaneous morning erections become more frequent;

• improvement of libido;

• rehabilitation of ability to conduct a sexual intercourse;

• rehabilitation of quality of erections in a sexual intercourse;

• >increase in the duration of sexual intercourse.

Unacceptable errors when conducting the laser-vacuum therapy

Own clinical experience and communications with the doctors working under this techniques enabled me to reveal the most frequent and typical errors in the session technique.

1. Failure to observe the depressurizing mode. If depressurizing in the vacuum cup is conducted too quickly (in properly conducted session the depressurizing to 40 kPa should be achieved within 20–25 seconds), while not all cavernous bodies of penis are extended and filled with blood, then pubis skin and subjacent cellular tissue is sucked into the cup causing disturbance of blood flow and preventing erection.

2. Excess level of depressurizing in vacuum cup up to 5060 kPa and more, till it withstands. In this case, overstretching of cavernous tissues and blood vessels occurs; it can result in rupture of a cavernous body with subsequent possible development of cavernous fibrosis.

3. Exposure at the value of pressure reduction of 40 kPa not within 4060 seconds but 56 minutes and more. It is particularly gross error sharply disturbing blood circulation in the penis causing multiple haemorrhages with the subsequent degeneration and atrophy of cavernous bodies.

4. Unjustified increase in the number of sessions. Prescription of more than 15–20 sessions per one course of treatment is not reasonable and results in undesirable results. A distinct effect appears already after 4th – 5th session provided that the sessions are conducted properly.

5. No sufficient contact with the patient in the course of session. Underestimating of the patients sensations, his complaints can result in a variety of unpleasant consequences, ranging from oedema of prepuce with development of temporary phimosis to the development of syncopal state.

Contraindications to laser-vacuum therapy are:

• acute inflammatory diseases of prostate gland and urethra;

• urogenital zone skin diseases;

• sickle-cell disease;

• neoplasms of penis;

• mental illnesses;

• necessity to use antiaggregants regularly;

• Peyronies disease;

• trauma and operative interventions in the penis in the past medical history.

15. Traumatic ureteric fistulas

The secondary stenosis occurs often at the place of ureter implantation after plastic surgery on the lower third of ureter: inflammation in the zone of anastomosis and surrounding tissues resulting in long-term anastomostitis due to claviform oedema and post-operation trauma. Often, so-called irritable bladder is formed.

Laser therapy shall begin from the first day after operation and is conducted daily using Mustang 2000 or Mustang 2000+ laser therapeutic device. LO4-2000 radiation probe, pulsed power 7–10 W, frequency 80 Hz. Contact-mirror technique. Action on zones 3, 4 and 5 (Fig. 9) within 2 min. per each zone.

16. Urogenital infection, urethritis

Increase in sexually transmitted diseases makes to search the new approaches to solve this problem. According to the literature, main group among the agents of disease are chlamydia, mycoplasmosis, ureaplasmosis and gardnerellosis. For instance, more than 50 million people in the world are affected by urogenital chlamydia, and its occurrence is 2-5 times more than gonorrhoea. Such high rate of infection contamination of the population makes it necessary to develop the new, more efficient tools and methods of diagnostics, treatment and rehabilitation of the patients with this pathology.

The relative share of urethritis, cervicitis achieves 60–70%. Often, chlamydia is combined with ureamycoplasmosis and has weak clinical presentations and it complicates the timely treatment. Chronic forms of the disease often resulting in sterility dominate as a result of infection with the mixed urogenital flora.

Treatment of chronic infectious urethritis is currently a major challenge. The literature provides plenty of therapeutic treatment schemes, but the most efficient appeared to be a complex approach proposed by S.N. Dzhumaliyev et al. (2000), who applied in chlamydial and ueramycoplasmal infection a specific antibacterial therapy taking into account the antibiotic sensitivity (Cifran, Ciprobay, Ciprofloxacin, Sumamed, Rovamycine) in combination with LT based on a complex technique. After the 5th – 6th session the patients general well-being was improved, pain syndrome was decreased, the inflammatory infiltrates were reduced thanks to enhancement of local blood flow, adhesive process was resolved, and the somatic temperature was normalized. As a result of conduct of the therapeutic treatment courses it was noted in the patients the intensification of function of adrenal cortex with increase of content of 17-oxyketosteroids by 7–9% that speaks for significant activation of hormone system. The quality of follicle-stimulation hormone increased by 2–5%, intestinal cell-stimulating hormone by 3–6%, lactogenic hormone by 5–7%, which undoubtedly had an impact on restoration of reproductive function of female gonads. Spermogram parameters improved significantly: pH value of 17 patients was restored, the number of active sperms increased, the sperm agglutination occurrences disappeared, the content of pathogenic sperm cells reduced markedly. The treatment conducted has resulted in impregnation in 15% of women having long-term infertility [Dzhumaliyev S.N., 2000]. Similar data were got by I.A. Diakov (2000).

Technique 1: ILBI using Mulat-M10 laser therapeutic device, wavelength 0.65 m, optical radiation power at the light-guiding fiber output 1.5–2 mW, daily or every second day, 15 sessions per course.

Technique 2: transcutaneous contact using Mustang 2000 or Mustang 2000+ laser therapeutic device, MLO1K-2000 IR-pulse radiation probe of matrix type, wavelength 0.89 m, pulsed radiation power 40–60 W, wavelength 80–1500 Hz, on tender points (hepatobiliary, lumbosacral zones, the region of thyroid body and thymus gland), exposure 30–60 sec., 7–10 sessions per course.

Technique 3: transcutaneous contact using Mustang 2000 or Mustang 2000+ laser therapeutic device. LO4-2000 radiation probes with ZM50 magnetic attachments, frequency 80–600 Hz, output radiation power 15–17 W, on the area of epididymis projection, exposure 30–60 sec., 7–10 sessions per course.

Technique 4: endocavitary using Mustang 2000 or Mustang 2000+ laser therapeutic device. LO4-2000 radiation probe (pulse, wavelength 0.89 m, frequency 80–150 Hz) and KLO3-2000 radiation probe (continuous, wavelength 0.63 m), maximum power, alternately, by 5 min., in 2 min., using U-1 urethral attachment, intra-urethrally, moving from sphincter outwardly, 10–15 sessions per course.

17. Penile fibromatosis (Peyronies disease)

Peyronies disease (PD) is a deformity of penis connective tissues which is featured by local fibrosis with change in the collagen structure and damage of elastinic base of penis albugineous tunic which changes gradually the anatomy of penis and can result in erectile dysfunction [Gelbard M.K. et al., 1990; Lue T.F., 2002].

As of today, PD therapy is one of the most challenging and contradictory problem of the modern urology that is caused in many instances by no consensus regarding the disease progress in spite of the achieved success in understanding of certain most important PD development mechanisms.

The modern concept of PD pathogenesis considers the formation of plaques in PD as a process representing by a chain of genetic, structural and immunologic occurrences which valid reasons, however, are not fully explored yet.

Magneto-laser therapy, included into the complex of conservative therapy is applied in the treatment of acute stage of disease. The operative therapy is applied during the stabilization of indurative process in order to repair any penile deformation at erection.

Having objectively identified the acute stage of PD by conducting U/S-angiography or soft X-ray tomography of penis with contrast enhancement it is recommended to conduct the third diagnostic stage, which includes an immunoassay to the extent of examination of -lymphocytes and their sub-populations (CD3, CD4, CD8) cell-bound immunity and enzyme-linked immunoassay of antibodies to herpes simplex virus 2 (HSV-2), as well as a study of interferon profile to the extent of analysis of virus-induced α-interferon and mitogen-induced γ-interferon for the purpose of determining the scope of pathogenic therapy of PD acute stage.

The mandatory components of a conservative therapy course are magneto-laser exposure of the area of albugineous tunic affection and vitamin E as antioxidative therapy. The scope of therapy depends on the presence of penile deformation at erection. If the presence of erectile deformation is detected, the complex of the conservative therapy should include injections in the region of A-intron affection or Verapamil for stopping and regressing the fibrosis of albugineous tunic. Moreover, it should be taken into account that the efficiency of the treatment assessed by reduction of penile deformation angle will depend on its value detected primarily and will be considerably higher in case of A-intron than Verapamil.

In case if chronic HSV-2 infection is detected it is necessary to add to the complex the treatment with the use of injections of Verapamil anti-virus therapy that improves considerably the efficiency of the therapy as a whole. Application of A-intron injections is not required in case of detection of chronic HSV-2 infection, because the preparation has a pronounced immune-modulating and antiviral activity. If cellular immunity deficiency and/or virus-induced α-interferon and mitogen-induced γ-interferon it is necessary to add to the treatment course A-intron in the form of injections in the area of affection or intramuscular with control study of cell-bound immunity and interferon profile once per month.

U/S-monitoring studies in full standardized scope are recommended for conduct every 4 weeks of conservative therapy to control any change in plaque dynamic, possible appearance of the new indurative elements, as well as to monitor fibroplastic induration activity. It is recommended to complete the course of conservative therapy with following obligatory supervision of the patient within a year in case if chronic stage of disease is detected.

The laser therapy is carried out by contact, stationery, with magnetic attachment. Radiation optical band – red (wavelength 0.63 m, KLO4-2000 radiation probe (Fig. 13)), biosynchronized modulation according to the heart and respiration rate (BIO controller), radiation power (without modulation) – 20 mW. Magnetic static field induction – 150 mT. Total exposure time – 15 min. per one session, daily, the first 2 weeks - once a day, and then 2 times per week.

A-intron injections in the area of albugineous tunic affection shall be made twice a week at the dosage of 1 to 3 mln. IU under the control of interferon status indices. The injections of Verapamil in the area of albugineous tunic affection are made twice a week at the dosage of 2.5 mg.

Monitoring ultrasound investigations of penis with the use of U/S-angiographic methods for the purpose of assessing the activity of indurative process shall be made once per month during the course of therapy. Establishing a stable phase is a basis for termination of the course of conservative therapy. On average, the course scheme of IFN therapy is from 40 to 60 mln. IU [Ivanchenko L.P., 2007].

18. Chronic renal insufficiency

Over the years M.B. Lutoshkin (2003) has observed a large group of patients with chronic renal insufficiency, which treatment was carried out by conservative methods for several reasons. The complex therapy included also LLLT action with a positive result. Lack of renal functional reserve remained in the patients, but there was recorded the reduction in rate of renal insufficiency progression, reduction in the level of urea, creatinine, medium molecules in blood serum. A part of these indices had statistically-valid differences, but only in the patients with chronic renal insufficiency of stage I.

LT technique: ILBI using Mulat-M10 laser therapeutic device, optical radiation power at the light-guiding fiber output 1.5–2.0 mW, duration of one session 25–30 min, 10–12 daily sessions per course. Repeated course of laser therapy in 6 and 12 months. Then the repeated courses of laser therapy every 6–12 months during 5–10 years [Lutoshkin M.B. et al., 2004].

19. Chronic pyelonephritis

Pyelonephritis is the most common infectious-inflammatory disease of the mucous membrane of the urinary tract and tubulointerstitialtissue of kidneys. The share of pyelonephritis is more than half of all patients with diseases of the upper urinary tract. The incidence of pyelonephritis is closely dependent on gender and age. Women of young and middle age suffer from this disease 5 times oftener than the men. This is due to the anatomical and physiological characteristics of the female body. Despite the widespread use of different groups of antibacterial drugs a growth of this disease occurrence, disability and increased mortality are noted due to it.

Due to the fact that chronic pyelonephritis is the primary cause of renal insufficiency and nephrogenic hypertension, active treatment should begin with the first days of recrudescence and continue until elimination of all signs of inflammation. In recent years, the treatment of chronic pyelonephritis made significant progress thanks to the introduction in the medical practice the laser and especially magneto-laser therapy. These treatment methods improve the microcirculation and blood rheology in the area of inflammatory focus; have anti-oedematous, desensitizing and immunomodulatory effects [Avdoshyn V.P., 1992]. At the same time, laser therapy promotes the concentration of drugs in inflammation focus and their potentiation [Andryukhin M.I., 1992].

Laser therapy and/or MLT is carried out as a part of a complex treatment, including antibacterial therapy, detoxification agents, immunomodulators, antioxidants, vasoactive drugs and antihypertensive drugs from the group of ACE inhibitors.

Evaluation criteria of treatment effectiveness are persistent improvement of general condition and stable improving of quality of patients living, the positive dynamics of clinical and laboratory study results. The data of the studies show a pronounced positive effect of the use of LLLT in treatment of the patients with chronic pyelonephritis in the acute phase. It is noted not only a positive trend of certain clinical and laboratory signs, but also a decrease in the length of stay of the patients in bed of an in-patient facility. Attention should be also paid to the fact that the patients receiving treatment course of LLLT have significantly less recurrences of acute pyelonephritis after passing both first and repeated courses of preventive MLT courses.

V.R. Sultanbayev (1993) recommends carrying out of ILBI for the patients with chronic pyelonephritis that is conditioned by optimization effect of LLLT on the antioxidant system.

Laser therapy course consists of 12-14 sessions once daily. The first 5-6 sessions – ILBI with radiation power of 1.5-2.0 mW, exposure time of 25-30 minutes. Then, a transcutaneous irradiation of the projection of the kidneys by pulsed IR-laser radiation (pulsed power of 6.4 W, frequency - 1500-3000 Hz, exposure 4 minutes per zone). During 1 session, action on 2-3 zones of the front, a middle and posterior axillary line is made. The induction of magnetic field is 50 mT. The patient lies on his side with underlying cushion. Two laser radiation probes of LO4-2000 type are applied simultaneously.

For the patients with syndrome of hypertension, additionally radiation of zones located paravertebral at the level of CIII–ThIII right and left simultaneously by two LO4-2000 radiation probes is conducted, 4-6 W pulsed power, frequency 80-150 Hz. Exposure of one field - within 1 minute. MLT course is repeated in 2 months and the third course – in 3 months after the second. In the future, the annual preventive course of MLT shall be carried out [Lutoshkin MB, 2003; Slastnikova EB, 1994].

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