RU1796144C - Method for rheography of prostate - Google Patents

Abstract

The invention relates to urology and can be used to determine the state of blood circulation in the prostate gland. The essence of the method is that the suprapubic region is punctured with a needle, the tip of the needle is brought to the outer surface of the anterior hemisphere of the prostate through paraprostatic tissue under ultrasound guidance, and the needle is used as the second electrode and for injecting drug solutions into the fiber. The positive effect consists in increasing the accuracy of the method, reducing the time of the diagnostic procedure, and monitoring the adequacy of treatment.

Description

The invention relates to medicine, more specifically to urology, and is intended to evaluate blood circulation in the prostate gland in chronic prostatitis.

 A known method of rheography of the prostate gland by introducing from the rectum side a spoon-shaped plastic electrode, on the concave surface of which two silver plates are placed, located 2 cm apart from each other so that they adjoin the front surface of the straight intestines in the projection of the right and left lobes of the prostate.

A disadvantage of the known method is its low accuracy, since it is impossible to control the location of the electrodes and their density adjacent to the front wall of the rectum. In addition, rheography exposes the site of the posterior semicircle of the prostate and interlobar sulcus, does not evaluate total blood circulation taking into account the anterior semicircle and selective right blood circulation

and the left lobe of the prostate. The results of rheography of the prostate are distorted by the imposition of blood supply to the wall of the rectum itself, i.e. rheography is indirect in nature.

A known method of rheography of the prostate gland by introducing one electrode made on the head of the catheter into the prostatic part of the urethra and another electrode made in the form of a plate on a special tip from the rectum. This method is adopted as a prototype.

The disadvantage of the prototype method is the low accuracy, since reogrphy is indirect in nature, the selective blood supply to the anterior hemisphere of the prostate is not evaluated, and the diagnostic and therapeutic methods of the procedure are not combined.

The aim of the invention is to increase the accuracy of the assessment by creating the conditions for direct rheography of the anterior hemisphere of the prostate and contracted

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the total time of the diagnostic and treatment procedure due to the combination of techniques.

This goal is achieved by the fact that in the method of rheography of the prostate gland, including the introduction of one electrode into the prostatic part of the urethra, the suprapubic region is punctured with a needle, the tip of the needle is brought to the outer surface of the anterior hemisphere of the prostate through paraprostatic tissue under ultrasound control, and the needle is first used as a second electrode, and then for infiltration into the fiber of drug solutions.

The method is carried out as follows.

The patient is laid on his back. Shave and process the skin of the pubic region. Under local anesthesia with 0.5% novocaine 20 ml, the suprapubic skin is punctured in the midline and, after a solution of novocaine has been dispensed, the needle is advanced posteriorly in the posterolateral space. The advancement of the needle is controlled using the ultrasound puncture point set above sensor. Under ultrasound guidance, the end of the needle is passed through paraprostatic tissue to the anterior external semicircle of the prostate. Then, a catheter, the head of which is made in the form of an electrode, is LOCATED along the urethra until it stops in the prostatic part of the urethra and the catheter is fixed to the glans penis with a band-aid. Then, the lead wires of the radiograph are connected respectively to the needle cannula and to the distal end of the catheter, and a direct rheogram of the anterior semicircle of the prostate gland is recorded. At the end of the rheography, the inserted needle is used to infiltrate the solutions of drugs (antibiotics, anesthetics) into the para-prostatic tissue, and the catheter drawn through the urethra is used to instill the posterior urethra and spermatic tubercle (silver nitrate, collargol solution, etc.). Thus, they combine diagnostic and therapeutic manipulations, which reduces the total time of the medical diagnostic procedure. Reography of the prostate gland is repeated after performing therapeutic manipulation and thereby control the effectiveness of the procedure.:

Example, Patient A., 40 years old. Diagnosis: chronic prostatitis. Complaints of pain in the suprapubic region, pain in the urethra, morning prostate, frequent and difficult urination, accelerated sem eruption. Suffers for 10 years. The disease periodically worsens. Antibacterial therapy with a temporary effect.

During the examination: the external genitalia are designed and developed correctly.

The external opening of the urethra is normal. Organs of the scrotum without pathological changes.

Rectal digital examination: the prostate is not enlarged, the contours of the gland are not clear, the surface is smooth, the consistency is dense. The median groove is pronounced. The study is painful.

Ultrasound examination of the prostate: iron 3.5 × 3.6 cm in size, echo-like 5 native, right and left lobes of the same size. Single small echopositive structures.

Analysis of the secretion of the prostate: white blood cells - 25-30 in n / a., Few lecithin grains. AT

Sowing the secret of flora growth was not revealed.

Urethroscopy (conclusion): chronic colliculitis.

The examination found that the patient is shown: infiltration

5 paraprostatic fiber with antibiotic solution with novocaine and instillation of the posterior urethra with 5% silver nitrate solution.

In addition, the question was raised whether vasoactive therapy was shown to the patient, which can be answered by an assessment of circulatory disorders in the prostate gland using rheography. The known method of rheography of the prostate is not 5 accurate enough and requires additional time. The method of rheography of the prostate was applied according to the claimed method.

The patient was laid on his back. The pubic area skin was selected and treated. Under local anesthesia with a 5% solution of novocaine 20 ml, the suprapubic area was punctured in the midline and the solution of novocaine was pre-injected, the needle was advanced in the posterior-lower direction in PB5 in the posterolateral space. The progress of the needle was monitored using the puncture site of the ultrasound probe set above. Under ultrasound control, the end of the needle was brought through a pair of prostatic tissue to the anterior external semicircle of the prostate. Further

A catheter was inserted through the urethra, the head of which was made in the form of an electrode, into the prostatic part of the urethra, and the catheter was fixed to the glans penis with a band-aid. Then, the lead wires of the rheograph were connected to the needle cannula and to the distal, respectively. end of the catheter and recorded a direct rheogram of the anterior semicircle of the prostate gland. On the rheogram, the upstream part is flat, on the downstream part several additional waves are detected. Their number varies in different cycles. The occurrence of such a curve is explained by obstruction of blood circulation in the prostate gland as a result of impaired venous outflow. A numerical analysis revealed a decrease in the rates of fast and slow blood supply, a decrease in the pulse wave propagation time, an increase in the peripheral resistance index and venous outflow coefficient, and a decrease in the rheogram amplitude and the blood filling period. That is, pulse blood flow is reduced, peripheral vascular resistance is increased, venous outflow from the gland is difficult. Spasmolytic and vasoactive therapy is shown in addition to paraprostatic blockade and instillation of the urethra. Additionally, prazosin preparations were prescribed at 0.001 x 3 times a day, troxevasin at 0.3 x 2 times a day.

Then, the outlet wires of the rheograph were disconnected from the cannula and from the catheter and the syringe was inserted into the cannula, into which a 5% solution of novocaine 20., 0, and 0.8 g of gentamicin was preliminarily taken. Paraprostatic was infiltrated with this solution.

fiber. The posterior urethra was instilled via a catheter with a 5% solution of silver nitrate. Thus, combined diagnostic and therapeutic manipulations, which

reduced the total time of the diagnostic and treatment procedure. After 3 days, the above procedure was repeated. The rheogram noted an increase in pulse blood flow, a decrease in peripheral

vascular resistance and obstruction of venous outflow. Thus, the adequacy of the prescribed therapy was confirmed. After four of these procedures with an interval of 3 days, clinical

improvement. The long-term outcome of the treatment is good.

Mostly the proposed method in comparison with the known consists in

creating conditions for direct rheography with the inclusion of the anterior semicircle of the prostate and the use of electrodes made in the form of a needle and catheter for subsequent medical manipulations.

The positive effect of the inventive method consists in increasing the accuracy of the assessment, reducing the total time of the medical diagnostic procedure, monitoring

for the adequacy of the treatment.

Claims (1)

The claims A method of rheography of the prostate gland, comprising introducing an electrode into the prostatic part of the urethra, characterized in that, in order to increase the accuracy of the method by performing direct rheography of the anterior hemisphere of the prostate and shortening the total time of the diagnostic procedure, the suprapubic area is punctured with a needle, the tip of the needle is brought to the outside the surface of the anterior hemisphere of the prostate through the steam-prostatic tissue by ultrasound monitoring and use the needle as an electrode for the administration of drugs.