Treatment of chronic prostatitis: magnetotherapy

Magnetotherapy is a therapeutic method based on the use of constant (CMF) or variable (VMF) low-frequency magnetic fields (MF). According to Yu. M. Raigorodsky et al. (2000), this method has a number of advantages over other physiotherapy methods. They are as follows:

• MP is the only field that penetrates the body’s tissues without weakening, which allows for direct impact on the pathological focus;
• MP, along with ultrasound, has the largest number of active factors, however, unlike ultrasound, it does not require contact methods of exposure;
• magnetotherapy is the most physiological type of therapy, since starting from the intrauterine development phase, a person is constantly surrounded by the Earth's magnetic field lines of force. Therefore, magnetotherapy is easily tolerated by most people;
• magnetic therapy has a minimal number of contraindications, in particular such as neoplasms, and its mild hypotensive effect allows it to be well tolerated by patients with hypertension;
• MP allows for the technically simplest implementation of the above-mentioned principles of optimal physiotherapy and especially the principle of dynamic impact with maximum biotropic saturation.

All this provides grounds for a wider application of the effect of MP on the body in various diseases, including chronic prostatitis.

At present, it can be considered an established fact that the effect of the magnetic field on the organism of an animal and a human is determined by a set of biotropic parameters of this field. The main ones are intensity (tension), gradient, vector, exposure, frequency, pulse shape, localization.

The PMF is most often characterized by only the first four parameters, although sometimes localization is of fundamental importance in the nature of its effect. The PMMF is also characterized by frequency. The pulse shape is added to the characteristic of the pulsed magnetic field (PMF). The running pulsed magnetic field (RPMF) has the largest set of biotropic parameters, the localization of which can change according to a given law. Moreover, in accordance with a given law, when using the RPMF, the localization of the PMF, and the PMF can be changed. Any of the modes is easy to implement if the RPMF is realized by a set of stationary MF emitters that are switched on sequentially one after another. In this case, the frequency that is addressed to the entire organism is called the RPMF modulation frequency. It is defined as the number of switchings in I s, divided by the number of emitters. If each emitter in the set operates in a pulse mode with a frequency higher than the modulation frequency, then the frequency of such RPMF itself becomes an additional (eighth) biotropic parameter.

Thus, BIMP, having a wider impact zone compared to other fields, is the most promising in terms of increasing the number of biotropic parameters. Let us note in passing that the rhythmic nature of the processes occurring in organs and tissues speaks in favor of any pulse therapy. Therefore, rhythmic (pulse) effects are closer to natural conditions and are more easily absorbed by certain systems of the body. In addition, adaptation to pulse effects (in contrast to continuous ones) develops to a much lesser extent; it becomes possible to significantly increase the dosage of the physical factor in the pulse and the variety of its physical characteristics. This helps to increase the individuality of physiotherapeutic treatment. It is important that the parameters of the pulse effect correspond to the rhythmic activity of the object, characterized by chronaxie, lability, accommodation, etc.

To study the body's reactions in normal conditions and in some types of experimentally induced pathology to general and local exposure to PMF, IMF with a strength of 3 to 100 mT and an exposure of 10 to 60 min, experiments were conducted on animals (rats, rabbits, dogs). General and local exposure (to the limbs) was carried out once and repeatedly (7-15 days). General and local exposure to MF with an induction of 35-50 mT for 20-30 min caused the appearance of functional and morphological effects, the development of which can be conditionally divided into three periods: primary reactions, stabilization and resolution.

In the first period, immediately after the cessation of the MP effect, an increase in ESR and the number of leukocytes, an increase in the index of platelet adhesiveness, coagulating properties of blood, its viscosity, the tone of blood vessels and their bioelectrical resistance were noted. Within 5 minutes, a slowdown in capillary blood flow and the formation of aggregates of formed elements of the blood were observed. Then, gradually, the phenomena of aggregation were replaced by disaggregation, blood flow rates and blood filling of vessels increased, vascular tone and bioelectrical resistance of tissues, blood viscosity and its coagulation indices decreased. By the end of the first day, even signs of hypocoagulation appeared.

The second period (2-4 days) was characterized by the stability of reactions that developed by the end of the first day. During the resolution period, the severity of the noted reactions rarely decreased. In some animals, they disappeared by the end of the second week, and in some, they were recorded for another month. With an increase in the magnetic field induction from 60 to 100 mT and exposure from 30 to 60 min, more pronounced changes appeared. In these cases, one third of the observed animals developed arterial and venous hypotension, electrocardiography recorded a slight decrease in the voltage of the QR complex, prolongation of intraventricular conduction, a decrease or increase in the 7th tooth, and hypercoagulation phenomena prevailed in the peripheral blood. In all animals of this group, the alignment of functional and morphological shifts occurred 2-3 weeks later than with exposure to a magnetic field with an induction of up to 50 mT for 20 minutes.

Exposure to magnetic fields with induction from 3 to 10 mT with exposure of 10-20 min caused improvement of peripheral blood circulation, increase of blood filling of vessels, decrease of their tone, bioelectric resistance, decrease of viscosity and coagulation function of blood in the first period. However, the second and third periods in these animals were short-term. By the end of 2-3 days the studied indices returned to the initial state. Exposure of the limb to magnetic fields with induction up to 50 mT and exposure of 20-30 min daily for 7-15 days also caused development of individual reversible and favorable reactions. Effect of PMF induced by devices and elastic magnets had identical effect. PMF and IMF contributed to appearance of more pronounced magnetobiological effects than PMF. In young individuals the character of studied indices was subject to greater deformation than in adults.

With repeated short-term impacts, as well as with long-term daily ones, a summation effect was noted. As the intensity of the MP and the course of its impact increased, positive and then negative physiological effects developed. This can be explained by the development of the training, activation and stress reactions. Multiple short-term MP impacts with induction up to 50 mT caused a wave-like change in the training and activation reactions.

The best therapeutic effect for the treatment of traumatic injuries of the extremities was obtained using MP with an induction of 5-10 mT and an exposure of 10 min for 2-3 days, which first caused a training reaction, and then with an increase in tension and exposure to 20-30 min, enhanced the activation reaction. This led to an increase in the body's resistance and acceleration of the processes of reparative regeneration of injured tissues.

The combination of small doses of PMF with VMF or IMF increased the positive effect of these MF. Based on the presented data, it can be concluded that in order to obtain the required efficiency of the therapeutic effect of the MF, it is necessary to limit the intensity to 50 mT. The therapeutic effect is achieved by stimulating the training and activation reactions by short-term and repeated effects with a constant increase in magnetic induction from 5 to 50 mT and exposure from 10 to 30 min or by means of simultaneous or sequential effects of PMF, VMF and IMF of small intensities.

In the body, the blood systems - vascular, endocrine and central - have the greatest sensitivity to MP. In recent years, interesting data have been obtained on the sensitivity of various links of the immune system of humans and animals to MP.

Evaluating the results of numerous studies, it can be concluded that the most characteristic changes in blood under the influence of MF are in the erythroid system. Reticulocytosis phenomena were observed regardless of the field strength and duration of exposure. The change in the number of reticulocytes serves as an indicator of the intensity of regenerative processes in the red blood system.

Under the influence of MP, changes occur in the blood coagulation system, the nature of some of which is determined by the initial state of this system and most often leads to the normalization of the coagulation process. The favorable effect of MP on microcirculation and vascular reactivity is also expressed in their normalizing effect on the tone and parameters of microcirculation. Thus, in MP, a change in the blood flow rate in arterioles, precapillaries and capillaries, an increase in the capacity of the vascular system, an increase in the diameter of capillaries and the density of capillary loops, and an acceleration of the formation of a collateral bed are noted.

The endocrine system response is expressed in increased activity of the hormonal and mediator links of the sympathoadrenal system (SAS), with the leading role in forming the endocrine system response being played by the hypothalamic centers. A normalizing effect of MP on the SAS has been revealed. A particular shift in it is associated with the formation of one of the three reactions of the body to MP as an irritant - adaptation, activation or stress. When studying the effect of MP on the reproductive system, the sensitivity of testicular tissue to it has been proven.

The course of infectious processes in the MP appears to be more favorable, especially in the presence of bacteriostatics or biogenic stimulants, which is explained by the stimulation of immunological reactivity or its normalization under the influence of the MP. It is not yet possible to explain the easier course of infectious processes under the influence of the MP by its effect on microorganisms, since information on the magnetic growth characteristics of bacteria in a nutrient medium and in the presence of drugs is very fragmentary and contradictory. So far, it can only be stated that the MP affects the metabolism and growth of microorganism cells.

The basis of modern ideas about the influence of the MP on a living organism is the concept of its action as an irritant. The organism responds to this irritation with an adaptive reaction of training, activation or stress. The formation of a particular reaction is determined by a set of biotropic parameters of the MP and the individual susceptibility of the organism to it.

Of the various types of MP, BIMP has the largest number of biotropic parameters and the greatest biological activity. It is promising from the point of view of resonant impact on organs and tissues, taking into account the rhythmic nature of the processes occurring in them. At the same time, the least development of adaptation to BIMP is observed compared to PMP or PMP.

The question of the mechanism of the influence of the MP at the cellular level has not yet been fully studied. However, there is already sufficiently convincing evidence of the participation of membrane processes in this mechanism, as well as calcium and magnesium ions. In particular, the MP affects the electrochemical potential and the protein-lipid component of the membrane, and the course of intracellular metabolic processes.

Modern ideas about the therapeutic properties of the magnetic field are based not only on the development of adaptive reactions under its influence. It is also important to enhance the effect of drugs in tissues located in the magnetic field. These can be vasodilator, analgesic, decongestant, sedative, neurotropic and, most importantly, phoretic effects. Studies were conducted on the effect of combined magnetic laser treatment on 24 patients aged 52 to 70 years suffering from stage I BPH with concomitant chronic prostatitis. The Uzor-2K device with a wavelength of 0.89 μm and a pulse repetition rate of 3000 Hz was used. One emitter with a magnetic attachment with induction up to 63 mT was installed on the perineum in the projection of the prostate gland, the second - rectally in the projection of the prostate. All patients were previously given sessions of intravenous laser blood irradiation (BLOK) for 25 min with a He-Ne laser with a wavelength of 0.63 μm and a power of 1.5 mW using the ALOK-1 device, which ensures repeated blood flow through the irradiation zone. The effectiveness of such a preventive measure for immunostimulation of the body before transurethral resection of the prostate was also reported in the work of G.V. Uchvatkin et al. (1997). On the 2-3 day, sessions of magnetolaser therapy with the above applications were performed for 3 min. Then this course was repeated 2-3 times. In all patients, dysuria significantly decreased or completely disappeared, the volume of the prostate gland decreased, urodynamics normalized, and pain symptoms disappeared.

Among other urological diseases in the treatment of which magnetic laser therapy was used, the following conditions can be noted:

• inflammatory and post-traumatic injuries of the genitourinary system;
• urolithiasis;
• hydronephrosis;
• chronic pyelonephritis;
• tuberculosis of the genitourinary system;
• sexual dysfunctions in men and women.

The optimal effect of the Ulan-Urat laser device on the restoration of urine passage, concentration and filtration functions of the kidneys, and stimulation of the passage of small stones was demonstrated.

The mechanism of combined magnetic laser therapy is associated with the effect of magnetophoresis, in particular on the protein-lipid cell membranes of the pathologically altered organ.

N.I.Tarasov et al. (1998) revealed correction of LPO shifts in the treatment of chronic prostatitis with tocopherol or ceruloplasmin in combination with rectal magnetotherapy and laser irradiation. According to V.A. Golubchikov et al. (2001), as well as M.Ya. Alekseev and V.A. Golubchikov (2002), the use of magnetotherapy in combination with laser irradiation and electrical stimulation in the complex treatment of chronic prostatitis leads to the summation of the action of these factors. As a result, the secretory function of the prostate is normalized, the activity of the inflammatory process is reduced, and the pain syndrome is relieved. In this case, the remission period lasts up to 2 years in 60.5% of patients.

Magnetic therapy was used to stimulate the immune system of patients with chronic prostatitis. For this purpose, the thyroid and thymus glands were irradiated with the Volna-2 device, the power of exposure was 30-40 W, the frequency was 460 MHz, the wavelength was 630 nm, the duration of exposure was 10-15 minutes daily, 15-20 procedures per course of treatment. The treatment was carried out on 57 patients with CP. As a result of the treatment, pain, dysuria and other symptoms disappeared or significantly decreased in 75.5% of patients. Prostatic secretion improved, the number of lecithin grains increased. An antibacterial effect was observed in 71.4% of patients. The content of T-lymphocytes increased and the number of B-lymphocytes decreased.

The obtained data indicated a stimulating effect of magnetic therapy on the T-cell link of the immune system when applied to the thyroid and thymus glands. As a result, a pronounced anti-inflammatory effect occurred, which led to the elimination of inflammation in the prostate.

According to V.A. Mokhort et al. (2002), the use of magnetic therapy in the complex treatment of chronic prostatitis contributed to the complete disappearance of complaints in 83.7% of patients, a decrease in the severity of symptoms in 16.2% and had no effect in 3.2% of patients. N.V. Bychkova et al. (2002) used magnetolaser therapy in the treatment of chronic prostatitis. They observed a positive clinical effect in 89% of patients, a decrease in dysuric phenomena in 86%, and an improvement in sexual function in 54%.

According to Ya. L. Dunaevsky et al. (2000), magnetotherapy contributed to the regression of inflammatory changes in the prostate secretion in 82.4% of patients with chronic prostatitis, and their complete disappearance in 58.9% of patients. N. F. Sergienko and A. I. Goncharuk (2002) proved that local magnetic therapy in combination with drug treatment contributed to the disappearance of pain syndrome in 82% of patients after 2-3 procedures, and 14% showed a significant reduction. The authors recommend using magnetotherapy in the treatment of chronic prostatitis, especially calculous, when microwave therapy is contraindicated.

Summarizing the above and relying on the literary data of recent years on magnetic therapy, we can conclude that the therapeutic effect of the action of the magnetic field is due to the vasodilating,

Anti-edematous, immunostimulating and sedative effects. Finally, there is another property of MP when applied locally, thus providing magnetophoresis in the tissue of the drug. To optimize the physiotherapeutic effect, in particular in urology in the treatment of urethroprostatitis in men, it is necessary:

• increase the biotropic saturation of the influencing physical field (for example, magnetic);
• provide a combined effect of the main field with additional ones (for example, magnetic with laser and electric);
• warm up the mucous membrane of the urethra and prostate, since this not only accelerates the processes of ion transfer, but also creates the effect of partial sanitation in bacterial forms of urethroprostatitis;
• ensure access of the drug to the mucous membrane of the urethra and prostate to implement the phoretic properties of MP and local drug therapy;
• to perform micro massage of the urethra as a result of the force interaction of the external field with magnetically sensitive elements inserted into the urethra (through a catheter); - to provide the possibility of influencing the gland from both the urethra and the rectum. An example of the successful simultaneous use of all factors of the MP influence with the implementation of the physiotherapeutic effect is the Intramag device for magnetic therapy in urology. The device is intended for the treatment of inflammatory diseases of the genitourinary sphere in men and women, including urogenital infection. It contains a BMP emitter for men, made in the form of a groove, a set of urethral catheters-irrigators made in the form of elastic (polyethylene) tubes with holes on the side surface, and a set of catheters-heaters. Inside the elastic tube of the catheters-irrigators there is a metal spiral made of magnetic stainless steel and an electric heater.

During the treatment, a catheter-irrigator is inserted into the urethra, filled with a medicinal product and then placed in the emitter groove. After the device is turned on, the MP begins to move along the urethra in a zigzag, swinging the spiral. Thus, the force action of the MP is realized, which is accompanied by a micromassage of the mucous membrane of the urethra due to the oscillations of the catheter. Improvement in irrigation of the mucous membrane with a medicinal solution is also noted. The informational effect of the field is due to the choice of its frequency near 1 Hz or 10 Hz, which contributes to better absorption of this physical factor by the body and a more complete implementation of the anti-inflammatory effect. The phoretic effect of the field is provided by magnetophoresis, for the enhancement of which the device provides the ability to combine it with electrophoresis of the medicinal product into the mucous membrane of the urethra. For this purpose, the coil located inside the catheter has an external contact for connecting it to the active electrode of any standard galvanization device (the Potok device).

The possibility of conducting electrophoresis sharply increases the number of ions in the medicinal solution due to its dissociation, facilitating the task of the magnetic field to introduce them into the tissue. Yu.A. Kobzev et al. (1996) conducted a study on the effect of millimeter-range electromagnetic radiation (the Intramag device) on the perineum. This radiation allows, along with magnetotherapy, to perform electrophoresis of drugs, micromassage in the BMP and introduce magnetically controlled suspensions. After 4-5 procedures, patients noted the disappearance of pain in the prostate, a significant decrease in the number of leukocytes in its secretion, and restoration of sexual function. In parallel with the disappearance of clinical signs of prostatitis, positive shifts occurred in all links of the homeostasis system (procoagulant, anticoagulant, fibrinolytic). In the peripheral blood, protease activity was normalized, the ratio and quantity of T- and B-lymphocytes, the content of immunoglobulins approached the norm, the level of circulating immune complexes decreased and the bactericidal activity of serum increased. According to S.A. Suvorov (1998), magnetic therapy in patients with chronic prostatitis was accompanied by restoration of the fibrinolytic activity of the peripheral blood (increase in the total fibrinolytic, plasmin activity and the activity of plasminogen activators; decrease in antiplasmin activity), disappearance of pain in the gland, normalization of its surface. A decrease in the number of leukocytes and an increase in the content of lecithin grains in the prostate secretion were noted.