RU2225175C2 - Method for treating nephrolithiasis - Google Patents

Abstract

FIELD: medicine, urology. SUBSTANCE: in pre- and postoperative periods one should perform medicinal therapy due to intake of pentoxifyllin per 400 mg, escusan per 40 drops, alpha- tocopherol acetate per 100 mg, thymusamin per 20 mg, vasalamin per 20 mg, renisamin per 20 mg thrice daily. In the course of distance lithotripsy one should intravenously inject 800-1200 ml 0.9%-sodium chloride isotonic solution and 5 ml (100 ml) pentoxifyllin. The method enables to shorten terms of pre- and postoperational periods and increase efficiency of distance lithotripsy. EFFECT: higher efficiency of therapy. 2 ex

Description

 The invention relates to medicine, in particular to urology, and can be used in the treatment of nephrolithiasis by removing stones from the kidneys by remote lithotripsy.

 In everyday urological practice, the surgical method of removal (pyelolithotomy and nephrolithotomy) and the instrumental (ureterolithoextraction) are most often used to remove kidney stones (calculi) [1].

 However, the listed methods for removing stones do not satisfy the main requirement for surgical intervention - maximum efficiency with minimal trauma and maintaining the possibility of re-intervention. A number of indisputable advantages in comparison with traditional surgical interventions are the methods of treatment based on crushing stones into small fragments with the subsequent expulsion of these fragments naturally, during urination or by forced washing [2]. The advantages of these methods, called "lithotripsy", are that they practically exclude soft tissue trauma, suppuration of the wound, and the occurrence of ureteral fistulas. The method of extracorporeal fragmentation of calculi (the so-called distance lithotripsy), in which a focused beam of a series of shock waves formed in a bag of fluid is directed from the outside through the body tissues to the calculus located in the kidneys, liver, or in any other organ, is most developed. patient [3].

 However, as with any surgical intervention, one of the factors determining the effectiveness of distance lithotripsy is the selection of patients and their preoperative preparation, as with all the advantages inherent in remote lithotripsy, in the postoperative stage, the mobilization of many vital systems of the body is often required to expel fragments of the destroyed stone.

 The effectiveness of the treatment of various forms of nephrolithiasis is affected not only by the degree of change in kidney function as a result of impaired passage of urine and concomitant infection, but also by intraoperative ischemic damage to the renal parenchyma due to shock wave exposure during a remote lithotripsy session. This determines the need for preventive measures for early rehabilitation of the organ.

 The purpose of preoperative preparation during remote lithotripsy is to prevent complications that may occur as a result of surgery. In this regard, the following tasks are set for her: exposure to the urinary tract in order to prepare them for the passage of fragments of a destroyed calculus, treatment of a purulent-inflammatory process in the kidney for the prevention of acute purulent pyelonephritis in the postoperative period, improvement of renal circulation and stabilization of the renal membranes.

 A method of treating nephrolithiasis is already known, which includes the preoperative stage, remote lithotripsy and the postoperative stage [4], and the first and last stages include drug therapy, which consists of introducing antioxidants, anti-inflammatory drugs and drugs that improve renal blood circulation into the patient’s body.

 In a number of known methods of treating nephrolithiasis, various medications and tactics of their use in the pre- and postoperative stages of treatment are used. So, Neymark A.N. et al. [5] used isradipine (a calcium antagonist), which was administered 12 weeks before lithotripsy and within 1 month after it at a dose of 1.25 mg 2 times a day, which had a stabilizing effect on the state of the renal membranes. ON THE. Nechiporenko et al. [6] used oxyprogesterone capronate, which was administered intramuscularly once at a rate of 5 mg / kg, which allowed them to significantly reduce the incidence of renal colic from 35 to 15% in order to prevent ureteral obstruction (by inhibiting contractions of the ureter wall). There is also a method of protecting the renal parenchyma from shock waves using α-tocopherol acetate [7], which was used at 100 mg per day for 10-14 days before the remote lithotripsy. It is believed that α-tocopherol acetate prevents the activation of lipid peroxidation enzymes, in particular, it prevents the accumulation of malondialdehyde in erythrocyte membranes and reduces the level of diene conjugates immediately after distance lithotripsy.

 For the stage of remote lithotripsy N.A. Lopatkin et al. [8] recommend, at the preoperative stage, the use of drugs that affect the microvasculature of the kidney, such as aminophylline, pentoxifylline (up to 500 ml by infusion therapy). When using infusion therapy (up to 400-800 ml) in combination with drugs that improve microcirculation of the kidney, fractional injection of lasix to 20-30 mg is practiced, which leads to an increase in the efficiency of the destruction of stones by 35 ~ 40%.

 There is also known [8] a method of hydration of a kidney by intravenous administration of up to 800 ml of a 10% glucose solution.

 The disadvantages of the above methods of treatment are the lack of effectiveness from taking single drugs (isradipine, hydroxyprogesterone capronate, α-tocopherol acetate, etc.), the inability to use them for women in the second half of the menstrual cycle (hydroxyprogesterone capronate), the effect only on the arterial component of the kidney microvasculature (aminophylline, pentoxifylline), insufficient volume of injected fluid, preventing the creation of optimal conditions for fragmentation of calculi, impossibility USAGE infusion solution (10% glucose solution) for patients with diabetes. With these methods of treating nephrolithiasis, according to various authors, the effectiveness of remote lithotripsy is only 90-95% of cases, and complications such as acute pyelonephritis develop in 5.2-12.3% of cases, kidney hematoma - in 0.03-0 , 04% of cases, etc.

 Closest to the claimed is a method for the treatment of nephrolithiasis, proposed by A. V. Kazachenko et al. [9], including the preoperative period, remote lithotripsy and the postoperative period, on each of which the patient undergoes drug therapy, and drug therapy is performed on the preoperative and postoperative periods by taking α-tocopherol acetate and pentoxifylline into the body. At the same time, indomethacin is also introduced in the process of drug therapy, which reduces non-specific inflammatory reactions due to the traumatic effect of the shock wave. During remote lithotripsy, infusion hydration of the kidney is carried out, which, combined with complex drug therapy at the preoperative and postoperative stages, increases the effectiveness of remote lithotripsy, has a protective effect, and also promotes faster organ rehabilitation in the early postoperative stage.

 The disadvantages of this method are the long periods of drug therapy to remote lithotripsy and its low efficiency.

 The objective of the proposed method is to reduce the pre - and postoperative stage, as well as increasing the efficiency of remote lithotripsy.

 The problem is solved in that in the known method, including the preoperative period, remote lithotripsy and the postoperative period, on each of which the patient is subjected to drug therapy, moreover, drug therapy in the preoperative and postoperative periods is performed by taking α-tocopherol acetate and pentoxifylline into the body, in preoperative and postoperative period, drug therapy is carried out by taking 3 times a day of pentoxifylline 400 mg each, eskuzan 40 drops, α-tocopherol acetamide each 100 mg, thymusamine 20 mg, vasalamine 20 mg, renisamine 20 mg, and 800-1200 ml of 0.9% isotonic sodium chloride solution and 5 ml (100 mg) of pentoxifylline are intravenously administered during remote lithotripsy .

 In order to force diuresis, fractional introduction of 0.02 mg of Lasix into the infusion solution is used.

 The technical result of the method is to reduce the terms of pre- and postoperative periods to 3-4 days, reduce the level of complications and achieve a 100% effect with remote lithotripsy of kidney stones. The therapeutic effect is achieved due to the combined effect on the kidney of antioxidants, anti-inflammatory drugs and drugs that improve renal circulation in predetermined component ratios.

 The method is as follows.

 In the preoperative period, for three to four days, the patient undergoes complex drug therapy by taking 400 mg of pentoxifylline 3 times a day; hekusana 40 drops 3 times a day; α-tocopherol acetate 100 mg 3 times a day; cytamines (thymusamine, vasalamine and renisamine) 2 tablets (weight 10 mg) 3 times a day. It is possible to replace individual components with their analogues. In the presence of inflammation of the urinary tract, an additional 400 mg of nolicin is taken 2 times a day.

 In the process of remote lithotripsy for the same purpose, before exposing the kidney stone to a series of shock wave pulses, hydration of the kidneys and urinary tract is performed. Hydration of the kidneys and urinary tract is carried out by conducting infusion therapy, in particular by intravenous administration of up to 1200 ml of 0.9% isotonic sodium chloride solution (or 5% glucose solution with the addition of insulin for patients with diabetes mellitus) and 5 ml (100 mg) pentoxifylline.

 In order to force diuresis, fractional introduction of 0.02 mg of Lasix into the infusion solution is used.

 After performing remote lithotripsy in the postoperative period, the same drug therapy is used that was used in the preoperative period, but for 5-7 days.

 The method is illustrated by examples.

 Patient P. (medical history 381). Upon admission according to ultrasound data 01.03.2000, the renal parenchyma with diffuse changes in the structure of the renal sinus is heterogeneous. In the preoperative period, for 3 days, the patient received 400 mg of pentoxifylline three times a day, 40 drops of escusan three times a day, 100 mg of α-tocopherol acetate three times a day and cytamines (thymusamine, vasalamine, renisamine) 20 mg three times a day. In the process of remote lithotripsy, urinary tract hydration was carried out by conducting infusion therapy, in particular by intravenous administration of 1200 ml of 0.9% isotonic sodium chloride solution with the addition of 5 ml (100 mg) of pentoxifylline. In the postoperative period, the same drugs were used as in the preoperative stage, but for six days. The total period of stay of the patient in the hospital was 8 days. No postoperative complications were observed.

 Patient K. (case history 740) upon admission according to ultrasound data from 03.03.2000 - a stone in the pelvis of the right kidney with a size of 17-18 mm, kidney microlites, signs of chronic pyelonephritis are not excluded. At the preoperative stage, for 4 days, he received 400 mg of pentoxifylline inside three times a day, 40 drops of escusan three times a day, 100 mg of α-tocopherol acetate twice a day, and cytamines (thymusamine, vasalamine, renisamine) 20 mg three times a day, nolycin 400 mg twice a day. In the process of remote lithotripsy, urinary tract hydration was performed by performing infusion therapy, in particular, by intravenous administration of 1200 ml of 0.9% isotonic sodium chloride solution with the addition of 5 ml (100 mg) of pentoxifylline. In order to force diuresis, fractional (2 times 0.01 mg) Lasix administration was used. In the postoperative phase, the same drugs were used as in the preoperative period, but for seven days. The total length of stay of the patient in the hospital was 10 days. No postoperative complications were observed.

 Thus, the effectiveness of the claimed method for the treatment of nephrolithiasis lies in the fact that it allows you to reduce the time before and postoperative periods and increase the percentage of positive results of distance lithotripsy. This method can be used simultaneously in combination with any methods of physiotherapeutic effects on kidney stones. The method has already been used in clinical practice, 101 patients have been treated, while minor trauma and greater efficiency have been recorded.

 BIBLIOGRAPHY.

 1. Tiktinsky O. L., Alexandrov V. P. Urolithiasis disease. // St. Petersburg - 2000. - S.245-303.

 2. Martov A. G. and Pretzel B. M. Endourology and remote shock wave lithotripsy in the treatment of nephrolithiasis // Plenum of the All-Russian Scientific Society of Urology. Abstracts of reports. - Rostov on the Don, 1992. - S.112-114.

 3. Revunov A. F., Kuzmenko V. V., Lozinsky M. V., Matveeva N. B. Our experience of using remote lithotripsy in the treatment of urolithiasis. // The first Russian symposium on distance lithotripsy in urology. Abstracts. - Moscow. - 1992. S. 42-44.

 4. Dzeranov N. K. Remote shock wave lithotripsy in the treatment of urolithiasis. // Abstract of diss. for the degree of Dr. med. sciences. - M. - 1994.

 5. Neymark L.N., Zhukov V.N., Fidirkin A.V. The use of isradipine for drug protection of the kidney with distance lithotripsy. // Plenum of the Board of the Russian Society of Urology: Materials. - Saratov. - 1998 .-- S. 316.

 6. Nechiporenko N. A. Prevention of renal colic after lithotripsy of the kidney pelvis calculi. // Plenum of the All-Russian Society of Urology: Materials. - Perm, - 1994. - p. 227-228.

 7. Dzeranov K. K., Golovanov S.V., Drozheva V.V. Damage to cell membranes during distance lithotripsy. Membrane-protective effect of alpha-tocopherol. // Plenum of the All-Russian Society of Urology: Materials. - Perm. - 1994. - S.205-206.

 8. Pavlov Yu. V., Gumenetsky D.V. Hydration therapy to increase the effectiveness of distance lithotripsy. // Plenum of the Board of the Russian Society of Urology: Materials, - Saratov. - 1998. - P.319.

 9. Kazachenko A.V., Dzeranov N.K., Yanenko E.X., Beshliev D.A., Golovanov S. A. Ways to prevent kidney damage during nephrolithotomy or remote lithotripsy for nephrolithiasis. // Urology and Nephrology. - 1998. - 3, - S.10-13.

Claims (1)

A method of treating nephrolithiasis, including the preoperative period, remote lithotripsy and the postoperative period, on each of which the patient is subjected to drug therapy, and drug therapy in the preoperative and postoperative periods is performed by taking α-tocopherol acetate and pentoxifylline in the body, characterized in that in preoperative and the postoperative period, drug therapy is carried out by taking 400 mg of pentoxifylline 3 times a day, 40 drops of eskusan, 100 of α-tocopherol acetate mg, thymusamine 20 mg, vasalamine 20 mg, renisamine 20 mg, and during remote lithotripsy, 800-1200 ml of 0.9% isotonic sodium chloride solution and 5 ml (100 mg) of pentoxifylline are intravenously administered.