Features of the Course of Chronic Bacterial Prostatitis during the Combined Application of Laser Therapy and Sparfloxacin

The research is dedicated to studying the features of the course of chronic bacterial prostatitis in the context of complex treatment combining low-intensity laser therapy (LLLI) with the fluoroquinolone antibiotic sparafloxacin. The relevance of the work is due to the high prevalence of chronic prostatitis among the male population, the unresolved issues of diagnosis, and unsatisfactory results of traditional treatment, which require the search for more effective therapeutic approaches. The work considers the mechanisms of interaction between laser irradiation and the antibiotic, including photosensitization and the enhancement of the bactericidal action of sparafloxacin, as well as the evaluation of the clinical effectiveness of the proposed combined therapy.

The research includes an analysis of the oxidative status of the prostate gland tissue, physicochemical changes in sparafloxacin under the influence of LLLI, an assessment of urodynamic and hemodynamic parameters, as well as a comparison of subjective sensations of patients and the bactericidal effect under various schemes of antibacterial therapy. The scientific novelty lies in establishing a synergistic relationship between laser therapy and sparafloxacin, manifesting in the enhancement of the antibacterial properties of the drug due to the release of singlet oxygen during the photodegradation of the drug molecules.

Relevance of the Topic.

According to foreign and domestic literature, the most common disease in men today—chronic prostatitis (CP)—affects up to 25–40% of the male population (Deryavenko I.I., 1997; Loran O.B., 2000). Even higher indicators (up to 80%) are known (Tkachuk V.N., 1989; Arnoldi E.K., 1997). In recent decades, an increase in chronic prostatitis morbidity has been noted in all countries of the world (Berger R.E., 1996). It is believed that such a trend is associated with the widespread prevalence of a sedentary lifestyle, the influence of harmful environmental factors, non-compliance with rules of sexual life, the widespread and uncontrolled use of medicinal substances, the sensitization of the population, and other factors. Unfortunately, chronic prostatitis is often detected at late stages, when not only local but also pronounced extra-organ manifestations of the disease are already present. The reason for this is the late consultation of patients by doctors, and the absence of the latter of perfected diagnostic and treatment methods (Tkachuk V.N., 1989; Golubchikov V.A., 2002).

As a consequence of long-current chronic inflammation of the prostate gland (PG), sclerosis of its tissue is observed in some patients, violation of urodynamics not only of the lower but also of the upper urinary tract develops, and chronic renal insufficiency occurs. This can lead to temporary and even persistent loss of working capacity. The appearance of sexual dysfunction and fertility disorders in many patients serves as a cause for the development of nervous and mental disorders (Tiktinsky O.L., Kalinina S.N., 2001; Ruska K.M., 1998).

The variety and severity of clinical manifestations of the disease, the unresolved issues of its recognition, unsatisfactory treatment results negatively affecting such indicators as birth rate, divorce rate, and others, confer ever-increasing social significance on chronic prostatitis and require further study and the search for a solution to this urgent problem (Yunda I.F., 1987; Pshechnikova T.Ya., 1991; Deryavenko I.I., 1997; Loran O.B., 2000; Tiktinsky O.L., Kalinina S.N., 2001; Weidner W., 1991; and others).

Based on modern concepts of the role of violation of the microcirculatory vascular bed in the development of inflammation (Chernukh A.M., 1979; Akulovich A.I., 1984; Gonchuk A.I., 2001), violations of PG hemodynamics necessarily precede the development of CP. This process is considered dominant, as it is present under all etiological factors (hypothermia, dysrhythmia of sexual secretions, injuries, infection, etc.).

Violations of microcirculation of the PG contribute to a sharp decrease in metabolic processes in it, which is accompanied by a violation of barrier, secretory, insular, and motor functions. The disturbance of oxidative-reduction processes leads to the depression of secretory activity of the epithelium of this organ. As a result, the process of renewal of acini with a secretion containing factors of humoral and cellular immunity is disrupted, and its bactericidal properties decrease (Yunda I.F., 1984; Alyaev Yu.G., 2001; Daehlin L. et al., 1983).

Despite the fact that in recent years certain successes have been achieved in the treatment of chronic bacterial prostatitis (CBP), relapses of the disease are often noted, with a tendency for a persistent protracted course. Traditional complex treatment, applied to patients in order to stop the inflammatory process, proves to be insufficiently effective (Mavrov I.I., 1994; Titova T.M., 1998). Long-term use of antibacterial drugs negatively affects the normal functioning of various systems of the body, especially the microbiocenosis of the intestine (Krasnogolovets V.N., 1989; Chelishchev E.V., 2000; Deryavenko I.I. et al., 2001).

An important role in conducting etiopathogenetic therapy belongs to physiotherapeutic impact (Titova T.M., 1998; Meguro N. et al., 1993). In modern medicine, among these methods, low-intensity laser irradiation (LLLI) has become popular, possessing a pronounced anti-inflammatory effect, having a stimulating effect on general and local immunity, improving the permeability of the vascular wall and microcirculation in the focus of inflammation, and providing an analgesic effect. There are reports in the literature on the use of laser therapy (LT) in inflammatory diseases of the urogenital organs: acute pyelonephritis (Shabad A.L., Alazov S.S., 1989; Rodoman V.E., Avdoshin V.P., 1992), cystitis (Murzin A.G. et al., 1989; Yakovlev V.I. et al., 1989), acute epididymitis (Aliybekova S.A., 1985; Reshnikov L.L., 1990; Chinenny V.L., 1992), and in chronic prostatitis (Shakir R.R., Salikhov I.R. et al., 2000; Golubchikov V.A., Alekseev M.Ya., 2001).

Given that one of the factors of biological action of laser irradiation is photosensitization, the question arises regarding its use in combination with antibacterial therapy. Especially with fluoroquinolones, considering their phototoxicity. Synergy or antagonism will manifest when combining these components of complex CBP treatment. All of the above determined the goal and objectives of the research.

Goal of the Research: to study the features of the inflammatory process in the course of complex treatment of chronic bacterial prostatitis in the context of combining laser therapy and the fluoroquinolone antibiotic sparafloxacin.

Objectives of the Research:

1. To assess the oxidative status in the expressate of the prostate gland in chronic bacterial prostatitis using various methods of correction.

2. To study the effect of low-intensity laser irradiation on the physicochemical structure of sparafloxacin.

3. To investigate and compare changes in the volume of the prostate gland, urodynamic and hemodynamic changes in chronic bacterial prostatitis and under various methods of correction.

4. To conduct a comparison of the subjective assessment of their condition by patients with chronic bacterial prostatitis under the influence of sparafloxacin with laser therapy and without it, as well as laser therapy and cefotaxime.

5. To compare the bactericidal action of sparafloxacin on the microflora of patients with chronic bacterial prostatitis with low-intensity laser irradiation and without it, in comparison with the analogous application of cefotaxime.

Scientific Novelty:

For the first time, a synergistic relationship between laser therapy and sparafloxacin in the treatment of CBP has been established. An increase in the biological activity of low-intensity laser irradiation in combination with sparafloxacin has been noted. For the first time, an enhancement of the bactericidal effect of sparafloxacin in vitro on the main infectious agents causing CBP under the influence of LLLI has been revealed. For the first time, a direct effect of low-intensity laser irradiation on the physicochemical structure of the fluoroquinolone antibiotic sparafloxacin has been established, manifesting in the release of free O2 and an enhancement of the bactericidal effect.

Practical Significance:

The results of the research confirm the feasibility of single low-intensity laser irradiation in combination with sparafloxacin in the complex treatment of CBP. The advantage of combining laser therapy and sparafloxacin in the treatment of CBP has been demonstrated, compared to the analogous application of cefotaxime and the use of sparafloxacin without LT. The effect of phototoxicity of the antibiotic sparafloxacin upon exposure to laser irradiation enhances the bactericidal properties of the preparation, which suggests its optimal use and in other infectious inflammatory processes. The inclusion of free-radical mechanisms in the treatment process presupposes an increase in OFL and a decrease in AOA, requiring prophylactic use of antioxidants. Taking into account the decrease in the antibacterial properties of cefotaxime when using laser therapy, their combined use is inadvisable.

Propositions for Defense:

1. In the pathogenesis of chronic bacterial prostatitis, the infectious factor is secondary, supporting the inflammatory process. Timely and adequate sanitation of the focus of infection is a positive prognostic sign of the outcome of the disease. The combined use of the antibiotic sparafloxacin and laser therapy leads to an increase in the effectiveness of antibacterial treatment of CBP.

2. Singlet oxygen, released during the photodegradation of sparafloxacin molecules under the influence of low-intensity laser irradiation, is the cause of the enhancement of the antibacterial properties of this fluoroquinolone and a shift of pH to the alkaline side, allowing an increase in the bactericidal properties of phagocytes and a decrease in the manifestation of acidosis in the focus of inflammation. As the study has also shown, it manifests its own bactericidal properties, increasing the zone of growth inhibition of microflora around discs with sparafloxacin.

3. When combined use of laser therapy and sparafloxacin in the treatment of chronic bacterial prostatitis, a reliable increase in the level of malondialdehyde, as an indicator of OFL, and a decrease in the level of ceruloplasmin, as a criterion of antioxidant activity, were not noted in the expressate of PG compared with the comparable groups.