RU2203673C2 - Method for treating chronic prostatitis - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: before starting conventional therapy one should carry out intravenous infusions of ozonized 0.9%-physiological solution once daily for 8-10 d. Ozone concentration in solution corresponds to 500-600 mcg/l. Infusion rate is 110-120 drops/min, volume is 5-6 ml/kg patient's body weight. At the middle of ozonotherapy course one should simultaneously conduct antibacterial therapy, physiotherapy, prostatic massage and urethral instillation of ozonized 0.9%-physiological solution. Ozone concentration in solution corresponds to 800-1000 mcg/l. Solution's temperature id 38-40 C, volume is 5-7 ml, exposure time is 10-15 min, twice daily for 10 d. The present innovation enables to interrupt inflammatory process and shorten therapy terms. EFFECT: higher efficiency of therapy. 1 ex

Description

 The invention relates to medicine, namely to surgery, urology.

Known methods of treating chronic prostatitis, including the use of immunological preparations, for example, intravenous administration of pyrogenal, the first dose of 2.5 μg, then the dose is increased by 2.5 μg or remains the same depending on the reaction daily or every other day. (Tiktinsky O.L., Mikhaylichenko V.V. Andrology - St. Petersburg, 1999, p. 150-156.)
The disadvantage is a violent reaction to the intravenous administration of the drug: body temperature rises to 38-39 ^o C and above, there is profuse sweat, weakness, tachycardia is observed, which can last for a day.

The following method is the use of moderate doses of male sex hormones, for example methyltestosterone 5 mg orally 3 times a day sublingually for one month; testosterone propionate in 1 ml of 5% solution intramuscularly 2-3 times a week in courses of 3-4 weeks. (Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis - M .: Medicine, 1998, p. 213: Arnoldi E.K. Chronic prostatitis - Rostov-on-Don, 1999, p.153-155.)
The disadvantage is that before the appointment of these drugs, it is necessary to have a detailed laboratory study of the level of sex hormones, which is not always easily feasible; the possibility of amplification by the feedback mechanism of the pituitary gonadotropic function, which can lead to hyperprolactinemia and estrogenization of the hormonal background.

Further, in the complex therapy, drugs that improve microcirculation and angioprotectors are used, for example, trental 5 ml is dissolved in 250-400 ml of 0.9% saline and administered intravenously, slowly, for 1-2 hours, heparin 2500ED 3 times a day, subcutaneously. (Tiktinsky O.L., Mikhaylichenko V.V. Andrology - St. Petersburg, 1999, p. 157; Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis - M .: Medicine, 1998, p. 215-216 .)
The disadvantage is the need for constant monitoring of coagulogram indicators. With the intravenous administration of trental, the development of hypotension is possible.

Some authors suggest a method of endourethral aspiration therapy using an electrode-catheter. Aspiration is carried out by creating a vacuum in the prostatic part of the urethra of approximately 0.3-0; 4 atm, the time of such exposure individually, on average 1-3 minutes. (Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis - M .: Medicine, 1998, p. 224-225; Arnoldi E.K. Chronic prostatitis - Rostov-on-Don, 1999. p. 159- 165.)
The disadvantage is that during the implementation of these procedures hypobarotraumatic injuries are possible (in the form of edema of the mucosa or urethrorrhagia), the possibility of developing "urethral" fever.

Very often, physiotherapeutic methods and laser therapy are used in the treatment of chronic prostatitis, for example, laser therapy using the Uzor-2K apparatus with two laser emitters, a wavelength of 0.89 microns and a power of 0 to 1 mW. The intensity of a constant magnetic field of 25-60 MT, the course of 10 days. (Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis - M .: Medicine, 1998.p. 216-220; Arnoldi E.K. Chronic prostatitis -Rostov-on-Don, 1999.p.184- 188 .; Tiktinsky O.L., Mikhaylichenko V.V. Andrology - St. Petersburg, 1999, p. 293-340.)
The disadvantage is the need to use expensive equipment, the narrow breadth of therapeutic effects.

 Closest to the claimed is a method of antibacterial therapy, for example a group of fluoroquinolones - ofloxacin (Tarivid) 200 mg orally 2 times a day - 10 days; or ciprfloxacin (Ciprinol) 200 mg 2 times a day intravenously for 5 days, then continue to take the same drug in tablet form, 250 mg 2 times a day for another 5 days, or Lomefloxacin (Maksakvin) 400 mg orally 1 time per day for 10 days or vibramycin 100 mg orally 2 times a day for 10 days, or doxycycline 100 mg 2 times a day intravenously, slowly, drip 5-7 days, etc.

 The duration of antibiotic therapy is at least 21 days. (Molochkov V.A., Ilni I.I. Chronic urethrogenic prostatitis - M .: Medicine, 1998, p. 173-184.; Arnoldi E.K. Chronic prostatitis - Rostov-on-Don, 1999, p. 138- 151.; Tiktinsky O. L., Mikhaylichenko V.V. Andrology - St. Petersburg. 1999, p. 124-145.).

 The disadvantage of this method is the need to use expensive drugs, the possibility of developing allergic reactions, dysbiosis, as well as hepatotoxic and nephrotoxic effects of some of them.

 The aim of the present invention is to increase the effectiveness of the treatment of chronic prostatitis.

This goal is achieved by the fact that in the complex treatment of chronic bacterial prostatitis, intravenous infusions of 0.9% saline solution saturated with ozone at a concentration of 500-600 μg / l, at a rate of 110-120 cap / min, in volume 5, are prescribed before traditional methods -6 ml / kg of patient weight, once a day, for 8-10 days. From the middle of the course of ozone therapy, antibiotic therapy, physiotherapy, prostate massage and instillation of 0.9% saline into the urethra, with an ozone concentration of 800-1000 μg / l, heated to a temperature of 38-40 ^o C in a volume of 5-7 ml, are simultaneously prescribed, with an exposure of 10-15 minutes, twice a day, daily for 10 days.

 Ozonated solutions have bactericidal, immunomodulating properties and the ability to improve microcirculation. In addition, ozone and ozonated solutions potentiate the effect of antibiotics.

Example
Patient K., 29 years old, was admitted to the clinic 06/17/01, I. B. 5715 with complaints: of drawing pains in the inguinal region on the right, heaviness in the perineum, rapid urination with cuts at the end, discharge from the urethra in the morning, at the end of urination. Sick for 3 years. The onset of the disease is associated with the transferred trichomoniasis, which was treated independently. After 8 months, the specified symptom complex developed. I went to the urologist of the clinic, during the examination I was diagnosed with chronic prostatitis. A course of anti-inflammatory therapy, massage of the prostate gland. After treatment, there was some improvement. Three months later, dysuric phenomena reappeared, drawing pain in the perineum. A repeated course of treatment was carried out, which did not have an initial effect, sent to a hospital.

 At admission: the general condition of the patient is satisfactory, pathology of the internal organs is not revealed.

 Local status: sponges of the urethra are slightly hyperemic, edematous, no discharge; per rectum: the gland has a chestnut shape, the right lobe is enlarged, its surface is uneven, there are patches of tuberosity and sagging, the left lobe is not enlarged, the surface is smooth, the consistency of the gland is doughy, the interlobular groove is smoothed out moderately, the use is painful, especially the right lobe. Cooper's seminal vesicles and glands are not palpable. The scrotum organs - without pathology.

 The total score (S) of the I-PSS test, adapted for chronic prostatitis (quantitative assessment of subjective manifestations), is 18; Quality of Life Index (L) is 4 (hard to say).

 In the general analysis of urine, there are a lot of squamous epithelium, leukocytes 2-3 in the field of view, mucus +; a smear from the urethra contains leukocytes up to 20 in the field of view, a lot of epithelium, a large number of gram-positive cocci and rods, gonococci, trichomonads, gardnerella, candida - not found.

 In PCR diagnostics for chlamydia, mycoplasmas, ureaplasmas, these pathogens were not found in the material. In the secret of the prostate gland: white blood cells up to 60-80 in the field of view, lecithin grains - few; when stained according to Romanovsky-Giemsa: races, trichomonads, gardnerell, candida - not found. When urine and prostate secretion are sown according to the Meares and Stamey method in the 1st and 2nd portions of urine, there is no growth; the secretion of the prostate gland is E. Coli, with the number of colonies per 1 ml - 560; in the third portion of urine obtained after massage of the prostate gland - 190, which confirms the etiological significance of the pathogen.

 The study of the coagulogram showed: hematocrit-70/30, prothrombin index - 103%, fibrinogen - 4.0, ethanol test - neg., Fibrinogen "c" - neg. When examining the ejaculate, it was found: increased viscosity -1.1, increased pH to 8.0, the number of spermatozoa in 1 ml - 40 million, spermatozoa with normal motility (category A and B) - 45%, category C - 25%, Categories d - 30%; white blood cells up to 15 - 20 in the field of view.

 Rheography of the prostate gland: on the rheogram, the ascending part was more gentle than normal, the additional wave was determined on the descending part, the speed of fast and slow blood filling was reduced, the propagation time of the rheographic wave was accelerated, the peripheral resistance index was increased, the rheogram amplitude was reduced.

 When assessing the patient’s immune status using monoclonal antibodies, the following were revealed: in the cell link, the decrease in the total number of peripheral blood T-lymphocytes was 45 (47-56), T-helpers 23 (24-42); an increase in the absolute number of T-suppressors - 21 (16-20), a decrease in the ratio of helper-suppressor T-lymphocytes - 1.2 (1.5-2.1); In the secretion of the gland, an increase in the level of secretory igA.

 Based on patient complaints, anamnesis, general and local status parameters, data from additional laboratory and instrumental methods of research, the diagnosis was made: chronic and follicular prostatitis, exacerbation.

Prescribed treatment, which began with intravenous infusion of 0.9% saline, saturated with ozone at a concentration of 500 μg / l; at a speed of 110-120 cap / min, in a volume of 400 ml (patient weight 74 kg), once a day, for 10 days, from the middle of the course of ozone therapy, traditional antibacterial therapy, physiotherapy, prostate massage and instillations were simultaneously prescribed the urethra of 0.9% saline, with an ozone concentration of 800 μg / l, heated to a temperature of 38 ^o C in a volume of 7 ml, with an exposure of 15 minutes, twice a day, every day for 10 days.

 By the end of treatment, pain and heaviness in the perineum disappeared, urination returned to normal, discharge from the urethra, regarded as prostatorrhea, and pain at the end of urination stopped by the middle of the course of treatment. The total score of the quantitative assessment (S) decreased to 4, the index of the assessment of the quality of life (L) - to 3 (satisfactory). General analysis of urine - norm (white blood cells - 0-1).

 In the control smear from the urethra: leukocytes up to 5-7 in the field of view, microflora - scanty, in the secretion of the prostate gland there was an increased level of leukocytes up to 20-25 in the field of view, the number of lecithin grains increased, after staining: gonococci, trichomonads, gardnerella, candida - not detected. When urine and prostate secretion are sown according to the method of Meares and Stamey, there is no growth. Coagulogram indices corresponded to the figures: hematocrit - 50/50, IPI - 88%, fibrinogen - 2.8.

 In the spermogram, the viscosity decreased to 0.5 cm, the pH decreased - 7.2; the number of sperm in 1 ml increased not significantly - 42 million; spermatozoa with normal motility (a and b) - 65%, category-25%, category-d - 10%; white blood cells - 2-3 in the field of view. When examining the gland per rectum: the shape and surface returned to normal, the palpation was painless, and the gland acquired a tone. TRUS control was not performed.

 Rheography of the prostate gland: revealed a normalization of the curve, the disappearance of an additional wave in the descending segment, a decrease in the index of peripheral resistance, an increase in the amplitude of the rheogram.

 In the immunogram of the patient taken the day after the end of ozone therapy, it was noted: in the cell link there was a slight increase in the total number of peripheral blood T-lymphocytes-47 (initial-45) / unreliable increase in T-helpers and a decrease in the absolute number of T-suppressors, respectively 24 (initial -23) and 20 (initial-21); helper-suppressor ratio remained reduced; the level of secretory igA in the secretion of the gland remained elevated.

 When evaluating the immunogram taken at the end of treatment, an increase in T-lymphocytes-50 (baseline-45), an increase in T-helpers - 31 (baseline-23), a significant decrease in the absolute number of T-suppressors - 16 (baseline-21), normalization were found helper-suppressor ratios - 1.939, initial -1.20, the level of secretory igA decreased compared to the initial values, but still remained above the norm.

 The patient was discharged for outpatient observation in satisfactory condition. Recommended regular sexual activity with a condom for 2 months, examination of the sexual partner at the place of residence, monitoring of the secretion of the prostate gland and TRUS of the prostate gland in a month.

 Using the proposed method allows you to quickly achieve improvement in the patient’s condition, there is no allergic reaction, faster to stop the inflammatory process, reduce the length of hospital stay, improve the quality of life by reducing the period of pronounced clinical manifestations.

Claims (1)

A method of treating chronic prostatitis, including traditional methods of treatment: antibiotic therapy, massage of the prostate gland, physiotherapy, characterized in that before the traditional methods of treatment, intravenous infusions of 0.9% saline solution saturated with ozone in a concentration of 500-600 μg / l are carried out at a rate 110-120 cap / min, in a volume of 5-6 ml / kg of patient weight, once a day, for 8-10 days, from the middle of a course of ozone therapy, antibiotic therapy, physiotherapy, prostate massage and other tillyatsii urethra in 0.9% saline solution with ozone concentration of 800-1000 mg / l, preheated to a temperature of 38-40 ^o C, in a volume of 7.5 ml, with an exposure of 10-15 minutes, twice a day, every day 10 days.