RU2248228C2 - Method and device for treating chronic prostatitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves concurrently acting with stimulating electric pulses and back pressure pulses upon the prostate from the large intestine side synchronized with the stimulating electric pulses under excessive rinsing solution pressure into posterior urethra region. Device has pneumatic massage unit as elastic shell enveloping hollow cylindrical casing having a row of radial holes for supplying compressed air into the shell and periodic pulsating pressure source having at least one unit for producing electric pulses and pneumo-electromagnetic valve which electromagnet anchor is connected to electric pulse production unit outputs. Unit for electrically stimulating perineal muscles and prostate having stimulating catheter electrode and reservoir containing rinsing solution attached to catheter electrode are available in the device. Electric stimulation unit output is connected to input of unit for producing pressure pulses. Periodic pulsating pressure source is manufactured as elastic pneumatic chamber brought in continuous mechanical engagement with electromagnet anchor of the pneumo-electromagnetic valve and tightly joined via tube, cylindrical tube cavity and radial holes therein to the elastic shell of the massage member.

EFFECT: enhanced effectiveness of treatment; accelerated treatment course.

3 cl, 10 dwg

Description

The invention relates to medicine, in particular to urology, and is intended for the treatment of prostatitis and their complications: potency disorders, infertility, vesiculitis, urethritis and other similar diseases.

A known method of treating patients with chronic prostatitis by electrical stimulation of the prostate gland, described, for example, in the Instructions for use of the urological electrical stimulator ESUR-30-3 "Intraton-3" [1]. The method consists in massaging the prostate with muscles, the contraction of which is forced under the influence of mid-frequency electrical stimulating pulses (2.5 kHz). As a result of the massage, the stagnant secretion is removed from the cavities of the prostate through the excretory ducts into the urethra.

It is known that due to electrical stimulation of the prostate, no more than 40% of patients are cured. Such a low efficiency of this treatment method is explained by the fact that when compression stress arises in the prostate, an expansion also develops in the rectal region. This prevents the effective removal of secretions into the urethra, and also leads to a high duration of treatment (more than 4 weeks).

A more effective way of treating patients with chronic prostatitis is by exposure to the prostate gland by several factors: mid-frequency stimulating pulses, laser irradiation and low-frequency stationary magnetic field, which is described in Russian patent No. 2118187 [2].

In accordance with the description of the invention, each of these factors acts on the prostate gland at the same time and, naturally, provides a known effect inherent in each of the mentioned treatment methods without exerting a qualitatively new effect on the prostate gland based on mutual influence. As a result, the authors of the method according to patent No. 211818 speak only about remission of prostatitis, and not about curing patients, with almost the same duration of treatment.

The objective of the present invention is to provide a new method of treating patients with prostatitis, which would be highly effective with a significant reduction in treatment time.

The goal is solved in that in the known method of treating chronic prostatitis (by draining the prostate gland when exposed to several therapeutic factors, one of which is stimulating electrical impulses), simultaneously with stimulating electrical impulses, the prostate is affected by counterpressure pulses from the colon synchronized with stimulating electrical impulses, with a constant supply of washing solution under overpressure in the posterior urethra.

Due to the simultaneous impulse pressure on the prostate gland both from the urethra and from the colon, it undergoes multilateral compression, which contributes to the directed withdrawal of stagnant secretion from the prostate cavities through the excretory ducts to the urethra. Due to the pulsed nature of the effect on the prostate gland, the compression period is always replaced by a rarefaction period, which contributes not only to the withdrawal of stagnant secretion into the urethral region when the compression pulse grows, but also to the absorption of the washing solution into the prostate cavity when the pulse decays.

The proposed method for the treatment of chronic prostatitis is carried out using a device containing a pneumatic massager in the form of an elastic membrane, covering a hollow cylindrical body with a number of radial holes for supplying compressed air to the membrane, a source of periodic pulse pressure, including at least an electric pulse generating unit and a pneumatic electromagnetic valve, an armature whose electromagnet is connected to the outputs of the electric pulse forming unit. According to the invention, an electrostimulation unit for the muscles of the prostate gland with a stimulating catheter electrode and a container for the flushing solution attached to the inlet of the catheter electrode are introduced into this device. The output of the electrical stimulation unit is connected to the input of the pressure pulse generation unit, and the source of periodic pulse pressure is made in the form of an elastic pneumatic chamber, which is in constant mechanical contact with the armature of the electromagnet of the pneumatic electromagnetic valve and is tightly connected through the tube, the cavity of the cylindrical body and through the radial holes in it with an elastic shell massage element.

To create excess pressure in the source of periodic pulse pressure, a pneumatic blower is connected to the tube between the elastic shell of the massage element and the pneumatic chamber through a shut-off valve.

This embodiment of the source of periodic pulse pressure is more reliable than the device known as the patent of Russia No. 2098067 [3], which is the closest analogue. Higher reliability is achieved by eliminating the use of a compressor and, as a result, from power electromagnets and other structural elements associated with them.

A method of treating prostatitis and a device for its implementation are illustrated by drawings, in which Fig. 1 shows a diagram of the application of factors affecting the prostate gland and, accordingly, a diagram of a device for treating prostatitis, Fig. 2 is a longitudinal sectional view of a massager, Fig. 3 4, 9 are sonograms of various patients made before and after treatment, and FIG. 10 is a schematic representation of a source of periodic pulse pressure.

The method is implemented as follows. The patient is laid on his back and, as shown in figure 1, an electrically conductive catheter 2 (stimulating electrode) is inserted into the urethra, and a passive electrode 3 of the unit 1 for electrical stimulation of the muscles of the perineum and prostate is placed in the buttocks. Through a conductive catheter 2, a special solution is introduced into the urethra coming from the reservoir 5. By adjusting the height of the liquid column in the catheter 2 in the posterior part of the urethra, excessive pressure is created, for which the penis is slightly squeezed by the elastic ring A. Through the anus, a pneumatic massager 4 having a longitudinal slit-like slot 13 (FIGS. 2 and 3) to provide directional deformation of the elastic membrane 9. The pneumatic massager 4 is set so that the slot-like slot 13 is in the projection of the prostate gland B, after which They create an initial pressure that ensures constant contact of the elastic membrane 9 with the prostate B. These manipulations provide a scheme for applying factors affecting the prostate B, namely: the simultaneous exposure to it of electrical impulses of the unit 1 of electrical stimulation of the muscles of the perineum and prostate gland, which pass from the stimulating catheter electrode 2 through the patient’s body to the passive electrode 3, and counter-pressure pulses generated by the pneumomasser 4 from the colon, synchronized with stimulating electrical impulses of block 1, with a constant supply of washing solution under excess pressure into the posterior urethra through the catheter 2 from the reservoir 5. As a block 1 of electrical stimulation of the muscles of the perineum and prostate gland, in this case, a domestic urological stimulator of the ESUR-30-3 type is used “Intraton-3” [1].

When an electrical stimulation pulse passes through the patient’s body, the muscles located in the prostate area contract, exerting external pressure on the gland. Synchronously with this, a pressure impulse acts on the prostate through the elastic element of the pneumatic massager 4 drawn to it. Thus, a comprehensive impulse pressure is exerted on the iron. Comprehensive compression leads to the fact that the stagnant secretion is removed from the cavities of the prostate through the excretory ducts into the area of the urethra, where the pressure is minimal.

After the passage of the electrostimulating impulse, the compression wave in the volume of the prostate gland is replaced by the rarefaction wave. The resulting relaxation of the prostate leads to the fact that the solution filling the posterior part of the urethra is absorbed through the excretory ducts, washing out the stagnant secretion. Effective leaching contributes to the excess pressure of the solution filling the cavity of the prostate due to microhydrodynamic shock that occurs when the compression changes to vacuum.

The implementation of this method is illustrated by examples.

Example 1. Patient V.R. Avetisyan, 42 years old, was hospitalized in the City Clinical Hospital No. 1 of Togliatti (medical history No. 2002/04969) from 01/08/2002. January 29, 2002. with a diagnosis of Chronic specific prostatitis. Parenchymal focal form. Chronic vesiculitis. Pain symptom. The patient has been suffering from chronic Trichomonas prostatitis for 18 years. Repeatedly (on average 2 times a year) took courses of conservative treatment for this disease. I turned for help to the City Clinical Hospital No. 1 of Togliatti in connection with a progressive deterioration in well-being, consisting in an increase in the pain symptom and increased errectile dysfunction.

A control examination of the patient was carried out before the start of a course of physiotherapy and at the end of physiotherapy. When examining a patient, a set of the following methods was used: collecting complaints; physical examination; microscopic examination of the discharge of the urethra, prostate secretion; bacteriological culture of prostate secretion; transrectal biplane ultrasound examination of the prostate and seminal vesicles. The course of treatment consisted of fifteen procedures conducted daily. The duration of one procedure was 35 minutes. Simultaneously with physiotherapy, the patient received systemic enzyme therapy. As a fluid used for irrigation of the urethra during physiotherapy, we used a specially prepared solution (according to the results of microscopy of the separated urethra and the tank for sowing the secretion of the prostate) consisting of antibiotics, enzymes and antiseptics.

After three physiotherapy sessions, the patient's pain symptoms disappeared, at the same time, a large amount of discharge from the urethra, having a purulent character, was noted. Microscopy of this discharge revealed Trichomonas (although Trichomonas was not detected during the initial examination!). A subjective assessment of the need to continue physiotherapy was carried out according to the results of a daily examination of the patient per rectum. According to the results of the first ten sessions, a slight increase in the size of the organ and a simultaneous decrease in pain during palpation of the prostate gland were revealed. At the end of the physiotherapy course, the prostate during palpation became almost painless, its consistency was elastic, although the dimensions remained somewhat increased. A microscopic examination of prostate secretion, performed at the end of a course of drainage therapy, revealed more pronounced inflammatory changes than before physiotherapy, although the patient did not have symptoms characteristic of exacerbation of chronic prostatitis. After the first ten drainage sessions, the patient noted an improvement in potency and sexual quality. Figure 4 shows the original, and figure 5 is a control sonogram of the patient V.R. Avetisyan.

Example 2. Patient M.R. Rezaev, 22 years old, was hospitalized in the City Clinical Hospital No. 1 of Togliatti from 02/01/2002 to 02/18/2002 (case history No. 2002/08117) with a diagnosis of Chronic specific prostatitis. Parenchymal-infiltrative form. Chronic vesiculitis. Pain symptom. Erectile disfunction. The patient has been suffering from chronic trichomonas prostatitis for 6 years. Three times received conservative treatment for this disease. I turned for help to the City Clinical Hospital No. 1 in connection with a progressive deterioration in well-being, consisting in an increase in a pain symptom and an increase in errectile dysfunction.

A control examination of the patient was carried out before the start of a course of physiotherapy and at the end of physiotherapy. When examining a patient, a set of the following methods was used: collecting complaints; physical examination; microscopic examination of the discharge of the urethra, prostate secretion; bacteriological culture of prostate secretion; immunological determination of titer of antibodies to chlamydia; transrectal biplane ultrasound examination of the prostate and seminal vesicles. The course of treatment consisted of fifteen procedures conducted daily. The duration of one procedure was 35 minutes. Simultaneously with physiotherapy, the patient received systemic enzyme therapy. As a fluid used for irrigation of the urethra during physiotherapy, we used a specially prepared solution (according to the results of microscopy of the separated urethra and the tank for sowing the secretion of the prostate) consisting of antibiotics, enzymes and antiseptics.

After five physiotherapy sessions, the patient's pain symptoms disappeared, while the appearance of a large amount of discharge from the urethra, which has a purulent character, was noted. Microscopy of this discharge revealed Trichomonas (although Trichomonads were not detected during the initial examination! - as in the first case). A subjective assessment of the need to continue physiotherapy was carried out according to the results of a daily examination of the patient per rectum. According to the results of the first twelve sessions, a slight increase in the size of the organ and a simultaneous decrease in pain during palpation of the prostate gland were revealed. At the end of the course of physiotherapy, the prostate during palpation became almost painless, its consistency was elastic, although the dimensions also remained somewhat increased. A microscopic examination of the secretion of the prostate, performed at the end of the course of drainage therapy, as in the previous case, determined more pronounced inflammatory changes than before physiotherapy, although the patient did not have symptoms characteristic of exacerbation of chronic prostatitis. After the first seven drainage sessions, the patient noted an improvement in potency and sexual quality.

In Fig.6 shows the original, and Fig.7 is a control sonogram of the patient M.R. Rezaev (after seven sessions).

Example 3. Patient A.N.Kadasyuk, 56 years old, was hospitalized in the City Clinical Hospital No. 1 of Togliatti from 03.15.2002 to 03.28.2002 (case history No. 2002/09961) with a diagnosis of Condition after BPH from 07/11/2001 and 02/08/2002. Chronic non-specific prostatitis. Parenchymal focal form. Chronic vesiculitis. Pain symptom. Erectile disfunction. The patient has been suffering from chronic prostatitis for 16 years. Repeatedly took courses of conservative treatment for this disease. The persistent effect of the therapy was not noted. In 2001, he underwent two operations - TUR of the prostate with an interval of 7 months for BPH (GIST. No. 6226-30 of 02/11/2002. Glandular papillary hyperplasia. Focal chronic prostatitis. (GISat for BPH. TUR.). Repeated operation was made in order to remove residual tissues, but as a result of carrying out it, the patient did not notice changes in well-being.

The immediate and distant postoperative period in both cases was accompanied by severe pain symptoms associated with exacerbation of chronic prostatitis, the presence of obstructive vesiculitis. To a large extent, the patient was troubled by pollakiuria. A complete lack of potency was noted. I turned for help to the City Clinical Hospital No. 1 in connection with a progressive deterioration in well-being, consisting in an increase in a pain symptom and an increase in errectile dysfunction, and the lack of effect from surgical treatment.

A control examination of the patient was carried out before the start of a course of physiotherapy and at the end of physiotherapy. When examining a patient, a set of the following methods was used: collecting complaints; physical examination; microscopic examination of the discharge of the urethra, prostate secretion; bacteriological culture of prostate secretion; PSA level determination; transrectal biplane ultrasound examination of the prostate and seminal vesicles. The course of treatment consisted of ten procedures conducted daily. The duration of one procedure was 35 minutes. Simultaneously with physiotherapy, the patient received systemic enzyme therapy. As a fluid used for irrigation of the urethra during physiotherapy, we used a specially prepared solution (consisting of antibiotics, enzymes, and antiseptics according to the results of microscopy of the separated urethra and tank for sowing prostate secretion).

After five physiotherapy sessions, the patient's pain symptoms disappeared, at the same time, a certain amount of discharge from the urethra, having a purulent-hemorrhagic character, was noted. Microscopy of this detachable specific flora was not detected. A subjective assessment of the need to continue physiotherapy was carried out according to the results of a daily examination of the patient per rectum. At the end of the physiotherapy course, the prostate during palpation became almost painless, its consistency was elastic, although the dimensions remained somewhat increased. A microscopic examination of the secretion of the prostate, performed at the end of the course of drainage therapy, as in the previous case, determined more pronounced inflammatory changes than before physiotherapy, although the patient did not have symptoms characteristic of exacerbation of chronic prostatitis. After eight sessions of drainage, the patient noted an improvement in potency and quality of sexual activity.

In Fig.8 shows the original, and Fig.9 is a control sonogram of the patient M.R. Kadasyuk.

Thus, the claimed method of treatment of chronic prostatitis with drainage of the prostate gland, as the main procedure, allowed to achieve almost 10% of the treatment effect of various categories of patients with an average duration of 10-15 days. Adequate drainage of the gland should be considered as a necessary and indispensable condition for the relief of inflammatory changes that have a stagnant component in their genesis.

In accordance with figure 1, a device for implementing this method of treating chronic prostatitis contains a block 1 of electrical stimulation of the muscles of the prostate gland with a stimulating electrode-catheter 2 and a passive electrode 3, a pneumatic massager 4, a reservoir 5 for flushing solution, a source of periodic pulse pressure, including a forming unit 6 of electrical pulses, a block 7 of a pneumatic electromagnetic valve and a pneumatic blower shown in FIG. 10 14. An electrode-catheter 2 is connected to the outputs of the electrical stimulation unit 1 and are passive electrode 3 as well as the inputs of unit 6 generate electrical pulses, and the output of unit 6 generate electrical pulses - to the input of unit 7 pnevmoelektromagnitnogo valve. Block 7 of the pneumatic solenoid valve tube 8 is connected to the pneumatic massager 4, and the capacity 5 for the flushing solution is connected to the input of the catheter 2.

Pneumatic massager 4 (figure 2) contains an elastic shell 9, covering a hollow cylindrical body 10 with a number of radial holes 11. The elastic shell 9 is closed by a cap 12 having a longitudinal slot 13. The longitudinal slot 13 of the cap 12 allows directional deformation of the elastic shell 9 when serving a portion compressed air into the hollow body 10, as shown in Fig.3.

The block 7 of the pneumatic electromagnetic valve (figure 10) and the pneumatic blower 14 are the main elements of the source of periodic pulse pressure. Block 7 of the pneumatic solenoid valve contains an electromagnet made in the form of a core 15 and an armature 16, which is able to oscillate with respect to the axis 17. The armature 16 is in constant contact with the outer surface of the elastic pneumatic chamber 18. Through the tube 8, the cavity of the housing 10 and the radial holes 11 are elastic the pneumatic chamber 18 is hermetically connected with the elastic shell 9 of the pneumatic massager 4, forming a single pneumatic system. To create excess pressure in the system “elastic pneumatic chamber 18 - elastic shell 9” to the tube 8 between the elastic shell of the pneumatic massager 9 and the elastic pneumatic chamber 18 is connected through a shut-off valve 19 pneumatic supercharger 14.

The device operates as follows. After installing the electrodes 2 and 3, the pneumatic massager 4 and connecting the container 5 to the catheter electrode 2 according to the procedure described above, they begin to pump air into the pneumatic system “elastic shell 9 - elastic pneumatic chamber 18” manually using a pneumatic blower 14. In this case, the elastic shell 9 deforms and exits through the longitudinal slot 13 of the cap 12, forming a cavity B, towards the prostate B. After the cavity B reaches the elastic membrane 9 in contact with the surface of the prostate gland B, and the elastic pneumocamera 18 comes in contact with the knock armature 16 in its upper extreme position, air injection is stopped and the closed pneumatic system via the lock valve 19. After performing these procedures, the device is ready to funutsionirovaniyu. Block 1 of electrical stimulation of the muscles of the perineum and prostate gland begins to feed 2 packs of bipolar stimulating pulses with a frequency of 2500 Hz to the catheter electrode, which pass through the patient’s body to passive electrode 3 with a repetition rate of 5 Hz. In parallel, these same pulses get to the inputs of the electric pulse forming unit 6, which isolates the low-frequency component and generates a sequence of synchronous pulses with a frequency of 5 Hz for feeding the pneumatic electromagnetic valve to the unit 7. Here, these pulses fall on the windings of the core 15, which attracts the armature 16, turning it relative to the axis 17. In this case, the armature 16 compresses the pneumatic chamber 18 and the air from it passes through the tube 8 into the cavity of the body 10 of the massager 4 and acts on the radial holes 11 the elastic membrane 9, causing the cavity B to become even more deformed towards the prostate B. Due to this, the elastic membrane 9 and the prostate B collide under the influence of air pulses and stimulating electric x pulses. Considering that the duration of the pulse train generated by block 1 is longer than the duration of the pulse action of the armature 16 on the pneumatic chamber 18, under the influence of residual forces, air from the elastic shell 9 returns to the elastic pneumatic chamber 18, and the armature 16 of the electromagnet returns to its original upper position, respectively.

Sources of information

1. Urological electric stimulator ESUR-30-3 "Intraton-3" TU2 893.027TU.

2. Boychenko O.A. (MChP "Intermedservice"). A method for the treatment of patients with chronic prostatitis. Patent of Russia No. 2119187, M. cl. A 61 N 1/36, claimed 02/28/94, publ. 08/27/98.

3. Guskov A.R., Guskov A.P. Massage device. Patent of Russia No. 2098067, M. cl. A 61 H 21/00, claimed 03/26/96, publ. 12/10/97.

Claims (3)

1. A method of treating chronic prostatitis by draining the prostate gland when exposed to several therapeutic factors, one of which is stimulating electrical impulses, characterized in that, simultaneously with stimulating electrical impulses, the prostate is affected by counterpressure pulses from the colon synchronized with stimulating electrical impulses pulses, with a constant supply of washing solution under excess pressure into the posterior urethra. 2. The device for implementing the method according to claim 1, containing a pneumatic massager in the form of an elastic shell, covering a hollow cylindrical body with a number of radial holes for supplying compressed air to the shell, a source of periodic pulse pressure, including at least an electric pulse generating unit and a pneumatic-electromagnetic valve, the electromagnet's anchor is connected to the outputs of the electric impulse formation unit, characterized in that a unit of electrical stimulation of the perineum and prostate muscles is inserted into it gland with a stimulating electrode-catheter and a container for flushing solution attached to the input of the catheter electrode, the output of the electrical stimulation unit is connected to the input of the electric pulse generation unit, and the source of periodic pulsed pressure is made in the form of an elastic pneumatic chamber in constant mechanical contact with the armature of the electromagnet of the pneumatic electromagnetic valve and connected hermetically through the tube, the cavity of the cylindrical body and through the radial holes in it with elastic a bosom of the massage element. 3. The device according to claim 2, characterized in that the pneumatic blower is connected to the tube between the cylindrical body of the massage element and the pneumatic chamber through a shut-off valve.

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