RU2428223C2 - Method of treating prostatopathy and device for implementation thereof - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely - to urology, physiotherapy. The method involves prostate exposure to low-frequency currents combined with exposed prostatic blood flow status monitoring. The monitoring procedure is enabled by an ultrasound Doppler sensor arranged on an electronic module. Reversible prostatic blood flow speed loss on the 2-5th minute of the session enables to state reduced spare capacities of a prostatic vascular bed, and the procedure is continued. In case of prostatic blood flow speed loss after the 8th minute of the session, the procedure is completed. Blood flow speed gain requires the procedure to be continued to 20 minutes. A number of procedures within the therapeutic course is shown by a tendency to reduce a number of Doppler ultrasound (DUS) values by the end of the procedure starting with the 12th session. If observing blood flow speed loss after the 12th session, the therapeutic course is completed. Otherwise, the treatment is continued, but not exceeding 20 sessions in the course. The method is implemented by a device for treating prostatopathy. The device comprises a rectal bipolar cylindrical electrode assembly. The assembly comprises two proximal circular electrode surfaces and a dielectric cylinder in between. Two distal circular electrode surfaces of the assembly are connected to an electrotherapeutic apparatus. Besides, the electrode assembly comprises three parallel ultrasonic combined sensors on the same straight line on a plane of a dielectric cylindrical surface. The assembly incorporates a cable from the sensors brought out from the distal end and connected to an ultrasonic diagnostic apparatus.

EFFECT: method and device provides higher clinical effectiveness ensured by electrotherapy simultaneously with prostatic blood flow monitoring with combination of electrotherapy functions and ultrasound assessment in the same device.

2 cl, 2 dwg

Description

The invention relates to medicine, specifically to urology, and is intended for the controlled therapy of hemodynamic prostatopathy (chronic prostatitis CP category III).

A known method of treating CP by performing rectal physiotherapeutic electric procedures of pulsed fluctuating stimulation (IFS) with a frequency of 10-12 Hz, a duration of 8-10 minutes, the number of sessions 10-20 daily or every other day.

Yu.M. Esilevsky. New approaches to the diagnosis and treatment of chronic prostatopathy. Biomedical Radio Electronics, 2001, No. 5-6, p.40-52.

A known method of treating diseases of the prostate gland, in which control over its progress and result is carried out by periodic rectal ultrasound dopplerographic examination (USDG). The result of treatment is determined by the indicators of ultrasound and echodoplerographic examination of the tissue of the prostate gland and its vessels.

Yu.G. Alyaev, Yu.M. Esilevsky, M.A. Ronkin, T.D. Zhuchenko et al. A systematic approach to studying the effect of the drug Levitra in patients with chronic prostatitis and erectile dysfunction. Urology, 2005, 2, p. 53-60.

The disadvantage of this method is the lack of accuracy due to the non-simultaneity of the processes of treatment and diagnosis, as well as the morbidity due to the need for repeated and frequent injections of the ultrasound probe into the rectum.

A known method of treating CP by conducting rectal physiotherapeutic electric procedures of pulsed fluctuating stimulation (IFS) with a frequency of 10-12 Hz for 8-10 minutes, the number of sessions 10-20 daily or every other day. At the same time, the adequacy of the procedures is monitored by obtaining information about the state of the prostatic blood flow from the same rectal therapeutic electrode, which simultaneously has the property of a rheographic diagnostic electrode. Treatment Parameters:

the number of procedures, rhythm, power, exposure, the adequacy of the procedure and course of treatment is estimated by the constellation of rheographic indicators.

“A method of treating patients with chronic prostatitis by the effects of pulsed fluctuating stimulation (IFS), characterized in that they additionally carry out monitoring rheography, evaluate rheographic parameters and if during the procedure the rheographic index of RI increases to 0.060 Ohms or more, then increase the exposure of IFS signals by 10- 30% and the procedure is continued for up to 20 minutes; if RI decreases to 0.030 Ohms or less, then the exposure of the IFS signals is reduced by 10-30% and after 5-10 minutes the procedure is stopped. "

RF patent No. 2203109, 2001. A method for the treatment of patients with chronic prostatitis and a device for its implementation / Yu.M. Isilevsky, SV Grachev, MA Ronkin et al.

The disadvantage of this method is the lack of effectiveness due to the evaluation of treatment parameters for insufficiently sensitive changes in rheographic parameters.

The latter method is closest to the declared methods and the achieved result, and therefore is selected as a prototype.

The known device "Angiodin-Procto" is a diagnostic ultrasound angio-dopplerographic analyzer, including a rectal sensor for echodoplerographic examination of rectal vessels.

Doppler ultrasound analyzer "Angiodin-Procto". Operation manual MDO 3.980.000.000 RE ver.01.07. Research and Production Company "Bioss", 2005. - S.1-29.

A disadvantage of the known device is the lack of a therapeutic bipolar electrode for electrotherapy on a diagnostic ultrasonic rectal probe, which makes it impossible to conduct controlled electrotherapy simultaneously with the diagnosis.

A device is known - medical and diagnostic rectal bipolar cylindrical electrode block containing two proximal circular electrode surfaces and a dielectric cylinder between them. Two distal circular electrode surfaces of the bipolar electrode block are connected both to the electrotherapy apparatus of pulsed fluctuating stimulation, and simultaneously with the electrodiagnostics apparatus, a rheograph.

"A device for the treatment of prostatopathy containing a source of electrical treatment signals (ELS), a connecting cable with an output of an ELS source and a rectal electrode unit containing two electrodes, characterized in that it further comprises a rheograph, a second connecting cable with a rheograph input and a multipole switch, when The electrodes of the electrode unit are connected to the input of a multi-pole switch, the three outputs of which are connected to the corresponding outputs of the ELS sources, and the fourth output is connected to the input of the re Rafa ".

Utility model of the Russian Federation No. 18477, 2001. A device for the treatment of prostatopathy / Esilevsky Yu.M.

A disadvantage of the known device is the absence in the electrode unit of an ultrasonic dopplerographic sensor, which makes it impossible to conduct a more accurate and less traumatic diagnosis of prostatic blood flow during electrotherapy.

The objective of the claimed method is to increase the effectiveness of treatment due to the simultaneous ultrasound dopplerographic examination of the prostate.

The objective of the claimed device is to combine the functions of electrotherapy and ultrasound evaluation of the therapeutic effect on the dynamics of prostatic blood flow.

The problem in terms of the method is solved by the fact that in the method of treating prostatopathy, including exposure to the prostate with low-frequency currents, for example, pulsed fluctuating stimulation (IFS), a rectal therapeutic electrode block and the removal of information about prostatic blood flow from the same block, a distinctive feature is that the effectiveness of the procedures is monitored by an ultrasonic dopplerographic sensor located in the electrode block.

The problem in terms of the device is solved by the fact that a device containing a rectal bipolar cylindrical electrode block, namely two proximal circular electrode surfaces and a dielectric cylinder between them, two distal circular electrode surfaces of the electrode block connected to an electrotherapy device, for example, pulsed fluctuating stimulation, is a distinctive feature is that the electrode block contains three parallel-connected ultrasonic transceivers on one straight line bones of a dielectric cylindrical surface, a cable from sensors, conducted inside the electrode block and brought out from the distal end, connected to an ultrasound diagnostic device, for example, Angiodin-Procto.

The method is as follows.

The claimed rectal electrode unit with a dopplerographic sensor is introduced, connected simultaneously to an electrotherapy apparatus, for example, a source of low-frequency currents — an IFS therapy apparatus, and to an ultrasound diagnostic apparatus, for example, Angiodin-Procto.

Smoothly increase the value of the pulsed rectangular electrical signal until a distinct tapping sensation appears in the projection of the prostate. At the same time, one of the paraprostatic vessels is selected by the magnitude of the Doppler signal of the blood flow velocity displayed on the Angiodin-Procto monitor and the graphic image of the Dopplerographic curves on the display and the dynamics of the maximum and minimum linear velocities, pulsation and resistance indices, and systolic-diastolic ratio are observed . Register data on paper every 3-5 minutes. With adequate therapeutic effect, an improvement in ultrasound dopplerographic (Doppler ultrasound) indices is noted, mainly an increase in the maximum blood flow velocity in the vessel (Vmax) from 5-7 cm / s at the beginning of the procedure to 9-12-15 cm / s at the end of the procedure. Usually the procedure lasts 8-20 minutes. When there is a tendency to decrease in these limits Vmax, the procedure is completed. If a temporary depression of indicators with their subsequent improvement is recorded at the 2-5th minute of the procedure, a reversible decrease in the reserve potential of the prostatic blood flow is noted and the procedure is continued. The second procedure is carried out the next day (or every other day - with a sharp increase in blood flow at the end of the procedure). Typically, a course of treatment requires 12-20 procedures. The specific number of necessary procedures is determined by the trend towards a decrease in ultrasound ultrasound indicators at the end of the "last" procedure.

The device (see Fig. 1) contains a bipolar electrode block (1), along the plane of the dielectric cylindrical surface (2) of which three 8 MHz ultrasonic transceivers connected in parallel (3) and an ultrasonic cable (4) run inside the electrode block are placed on a straight line and derived from its distal end. The cable (4) is connected to an ultrasound diagnostic device, for example, Angiodin-Procto (5), and the electric cable (6) is connected to an electrotherapy device, for example, a low-frequency pulse fluctuation stimulation generator (7).

The operating mode of the ultrasonic channels Fcenter = 8 MHz, continuous, pulsed.

The operating mode of the low-frequency generator F = 1 ÷ 80 Hz, pulse, modulated.

The device operates as follows.

Insert the bipolar electrode block into the rectum to a depth of 6-8 cm with the placement of ultrasound sensors in the direction of the prostate. They include an ultrasound diagnostic device, for example, Angiodin-Procto. The maximum pulsating noise and dopplerographic curve are recorded audiovisually (on the display and on paper). They turn on a low-frequency generator, for example, an apparatus of pulsed fluctuating stimulation, and gradually increase the signal size to a painless, distinct “tapping” in the prostate zone. Continuous audio-visual observation of ultrasound indicators is continued, periodically duplicating them on paper. When there is a tendency to a deterioration in blood flow, the devices are turned off, the procedure is completed, the electrode block is removed.

An example of a specific implementation of the method using the claimed device.

Patient B., 42 g. Complaints of pain in the inguinal regions, scrotum, perineum, rapid urination, worsening of an erection.

Anamnesis: Suffers for about six months.

Objectively: the external genitalia are formed and developed correctly. The testicles are in the scrotum, a test-like consistency, somewhat reduced in size. The appendages of the testicles are tight, painful.

Per rectum: the sphincter is tonic. The prostate is not enlarged, evenly sealed, the contours are even, the surface is smooth, the median groove is pronounced, the study is painful.

The secret of the prostate is 4-5 leukocytes in sight, there are few lecithin grains. Sowing the secretion of the prostate and scraping from the urethra is sterile.

Blood PSA: total - 2.9, free - 15%. Blood testosterone total - 11.5 nmol / L.

TRUS: a prostate with smooth contours, small hyperechoic foci in the right lobe, no hypoechoic foci. Sizes of the gland: 2.19 × 4.16 × 3.24 cm. Volume - 15.42 cm ³ .

Doppler ultrasound of the prostate: the vascular pattern is depleted, peak blood flow velocities in the right, left lobes and periurethral zone are 7, 6 and 7 cm / s, respectively (reduced, N = 12-14 cm / s). IR - 0.92, 0.88, 0.89 (increased, N = 0.67-0.75).

Penis ultrasound: peak velocities in the right and left deep arteries of the penis - 5 and 6 cm / s, respectively, IR - 0.85 and 0.83.

Diagnosis: Chronic prostatitis of the CV category (chronic pelvic pain syndrome, prostatism, prostatodynia, hemodynamic prostatopathy, ischemic pelvic disease, relative erectile dysfunction, relative androgen deficiency).

The treatment has been started according to the claimed method. Enter the rectum (in position on the left side) of the claimed electrode block. They include IFS and Angiodin-Procto devices. An audiovisually examined paraprostatic vessel is selected. The maximum blood flow velocity is 6 cm / s. The value of the IFS signal is increased until the patient senses a distinct “tapping”. Analyze a complex of ultrasound indicators. The most demonstrative of them is the maximum speed of blood flow in the prostate. The latter increases to 9 cm / s by the 10th minute of the session. At the 11th minute there is a tendency to a decrease in blood flow velocity - 8 cm / s. The session is over.

For 2-3 minutes from the beginning of the session there was a temporary depression of speed up to 5 cm / s, despite which the procedure was continued. This phenomenon is due to the fact that the vascular bed with reduced reserve capacity does not cope with the increased load caused by the physiotherapeutic procedure. Starting from the 4th minute and up to the 10th minute inclusive, the blood flow rate increased to 9 cm / s, indicating a reversible degree of circulatory failure in the prostate.

2nd - 17th procedures carried out according to the same plan. At the end of each of the sessions, blood flow increased to 9-13 cm / s (see Figure 2). At the end of the 18th procedure, there was a tendency to a decrease in blood flow - 10 cm / s. The course of treatment is completed. Treatment with effect.

The maximum blood flow velocities at the beginning and at the end of each procedure are presented in the table and graphically (see Figure 2).

The advantage of the claimed method compared to the known one consists in the simultaneous use of electrotherapy and ultrasound dopplerographic diagnosis of prostatopathy.

The technical result in terms of the method is to increase the effectiveness of treatment due to simultaneous ultrasound dopplerographic examination of the prostate.

The advantage of the claimed device is the placement on the medical rectal electrode unit of an ultrasonic dopplerographic sensor.

The technical result in terms of the device is to combine the functions of electrotherapy and ultrasound evaluation of the therapeutic effect on the dynamics of prostatic blood flow.

Claims (2)

1. A method of treating prostatopathy, including exposure to low frequency currents on the prostate for 8-20 minutes while monitoring the status of the prostatic blood flow every 3-5 minutes during the period of exposure, carried out using a rectal electrode unit, characterized in that the control is carried out with using an ultrasonic dopplerographic sensor located on the electrode unit, and with a reversible decrease in the speed of the prostatic blood flow by 2-5 minutes of the session, the decrease in reserve capacity with udistogo prostate bed and the procedure continues; with a decrease in the speed of prostatic blood flow after 8 minutes of the session, the procedure is completed; and with an increase in blood flow, the procedure is continued for up to 20 minutes; the number of procedures required for the course of treatment is determined by the trend towards a decrease in ultrasound dopplerographic (Doppler ultrasound) indicators at the end of the procedure, starting from the 12th session, while in the case of a decrease in blood flow velocity after the 12th session, the treatment course is completed, otherwise the treatment is continued, but not more than 20 sessions per course. 2. A device for the treatment of prostatopathy containing a rectal bipolar cylindrical electrode block — two proximal circular electrode surfaces and a dielectric cylinder between them, two distal circular electrode surfaces of which are connected to the electrotherapy apparatus, additionally contains three parallel-connected ultrasonic transceivers on one straight plane plane the dielectric cylindrical surface of the electrode block, a cable from the sensors, conducted inside the block and output and from the distal end, connected to an ultrasound diagnostic apparatus.

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