RU2254802C1 - Method for evaluating intraorganic testicular hemodynamics in children at cryptorchism - Google Patents

Abstract

FIELD: medicine, juvenile surgery, urology.

SUBSTANCE: the present innovation deals with ultrasound studying patient's scrotal organs to detect maximal systolic circulatory velocity V_SM and final diastolic circulatory velocity V_D, moreover, circulatory evaluation should be carried out by integral hemodynamic index J by the following formula J = 1 + (J_S - J_r), where J_S - hemodynamic index of systolic result-producing nature; J_r - hemodynamic index of reverse circulation. Moreover, J_S should be calculated by the following formula:

where t_S - systolic time, T_CC - time of cardiac cycle, as for J_r it should be calculated by the following formula:

where V_DM - minimal diastolic circulatory velocity, t_RC - time for reverse circulation. Application of the present method enables to increase information value in evaluating hemodynamics of gonads due to applying indices taking into account temporal parameters of vascular circulation.

EFFECT: higher efficiency of evaluation.

1 dwg, 1 ex, 1 tbl

Description

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

The reproductive health of adolescents largely depends on the results of treatment of diseases of the genitourinary system. Cryptorchidism, especially bilateral, leads to infertility in 40-80% of patients. An important role in the genesis of infertility is played by hemodynamic disturbances in the gonads, which are bilateral in nature due to the friendly vasomotor reaction of paired organs.

Modern ultrasound methods are the most informative in the diagnosis of blood flow disorders in the organs of the scrotum.

As an analogue of the method for assessing hemodynamics in gonads during cryptorchidism, the authors propose a method for determining vascular signals in the testicular parenchyma. The blood flow in the gonads is estimated by the results of color Doppler (CDC) and energy mapping (EDC). The results obtained are compared with the normative blood flow indices and the dopplerogram of the contralateral gonad (AR Zubarev et al. Ultrasound diagnosis of diseases of the external genital organs in men. - M., 1999 - P.79-81).

This method of assessing hemodynamics in cryptorchidism has the following disadvantages:

- assessment of the color cartogram is feasible in the presence of a second healthy gonad in the scrotum;

- with CDK it is impossible to assess the quantitative and qualitative indicators of blood flow.

The prototype of the method for assessing blood flow in gonads in children with cryptorchidism is a method for determining dopplerometric parameters, the most informative of which are the resistance index (IR) (MI Pykov et al. Ultrasound Diagnostics in Pediatrics. - M., 1998, Volume 4. S. - 493-516). The study is carried out using ultrasonic sensors with a frequency of 7.5 MHz. The resistance index is the ratio of the difference between the peak systolic and final diastolic velocity to the peak systolic blood flow velocity (Zubarev A.R. et al. Ultrasound diagnosis of diseases of the external genital organs in men. - M., 1999 - C 53-81). Indicators of peak systolic blood flow velocity in the normal intra testicular arteries are in the range from 8 to 26 cm / s (on average 12 cm / s). With cryptorchidism, the peak systolic blood flow velocity does not exceed 9-10 cm / s.

The average IR values for healthy adolescents is 0.621 ± 0.049. IR increases with spasm of the arterial bed and sharply decreases with arteriovenous blood bypass grafting and collateral type of blood circulation. In an undescended gonad, IR is usually high (0.8 and higher). After the testicle is reduced to the scrotum, blood flow is characterized by high peripheral vascular resistance. Moreover, the diastolic component of the Doppler spectrum has low speed indicators, often with zero or reverse blood flow. In such a situation, the resistance index does not provide reliable information about the state of the vascular bed.

The disadvantages of assessing blood flow in gonads with cryptorchidism using IR include:

- when calculating IR, only characteristic values of the linear blood flow velocity are taken into account, but the temporal parameters of blood flow in the vessel are not taken into account;

- in situations where the blood flow velocity in the diastole decreases to zero, IR loses its information content.

The authors propose a method for assessing blood flow in the gonads during ultrasound Dopplerometry with the determination of hemodynamic indices: hemodynamic index of systole performance (Jc) and hemodynamic index of back bleeding (Jo), which are determined by two components: speed and time. The hemodynamic performance index of systole is determined by the formula:

где

Where

V _CM - peak systolic blood flow velocity;

V _D - final diastolic blood flow velocity;

t _c - systole time;

T _cc - period of the cardiac cycle;

J _c characterizes the relative increase in the specific pulse volume of blood flow in the vessel due to cardiac output during systole. J _c - dimensionless, positive.

The hemodynamic index of reverse blood flow is determined by the formula:

где

Where

V _D - final diastolic blood flow velocity;

V _DM - minimum diastolic blood flow velocity;

T _cc - period of the cardiac cycle;

t _OK - time of reverse blood flow.

J _o characterizes the relative decrease in the specific pulse volume of blood flow in the vessel due to reverse blood flow (Fig1). J _{o is a} dimensionless quantity, positive and characterizes the relative decrease in the specific pulse volume of blood flow in the vessel.

In figure 1. presents the Doppler spectrum of blood flow velocity from the interlobular artery of the testis in a child with cryptorchidism: A - with reverse blood flow to diastole, B - normal.

V _CM - peak systolic blood flow velocity;

V _D - final diastolic blood flow velocity;

t _c - systole time;

T _cc - period of the cardiac cycle;

V _DM - minimum diastolic blood flow velocity;

t _OK - time of reverse blood flow;

t _d is the time of diastole.

The authors propose to evaluate the blood flow in the gonads by the algebraic sum of J _c and J _o according to the formula:

J = 1 + (J _c -J _o ), where

J is the integral hemodynamic index;

J _c - hemodynamic index of systole performance;

J _{o -} hemodynamic index of reverse blood flow.

The integral hemodynamic index characterizes the hemodynamic properties of the vessel and determines the pulse characteristics of the blood flow.

In order to determine the possibilities of assessing blood flow using hemodynamic indices, 45 children were examined, with various forms of cryptorchidism in the early postoperative period (7th day), aged 3 to 14 years. The control group consisted of 35 healthy children of the same age. A comprehensive ultrasound examination of the scrotum organs was performed on a 447 ZiPlus ultrasound scanner (Technos, Italy), using a linear sensor with a frequency of 7.5 MHz, color and pulse-wave Doppler modes. The results are shown in table 1.

In the control group, J ranged from 1.196 to 1.428.

Control group (35 children) Children with cryptorchidism (45 children) 1st group 2nd group 3rd group Jc 0.196-0.428 1,097-1,199 1,459-3,582 1,093-2,087 Jo - - - 0.028-0.288 J 1,196-1,428 1,097-1,199 1,459-3,582 1,093-2,087

Tab. 1. Indicators J _c , J _o and J in the control group and in children with cryptorchidism.

The integral hemodynamic index in children with cryptorchidism ranged from 1,093 to 3,582. According to the results of the studies, children with cryptorchidism were divided into three groups. In group 1, J ranged from 1.097 to 1.199 and was lower than in the control group. In the second group, J ranged from 1.459 to 3.582 and was higher than in the control group. The third group includes those patients for whom the diastolic component of the Doppler spectrum was characterized by a zero value of the diastolic flow rate. The values of J in children of the third group were directly dependent on the duration of the absence of blood flow in the vessel into the diastole and were variable (J was from 1,093 to 2,087).

Thus, the calculation of the integral hemodynamic index makes it possible to objectively evaluate the blood flow in the testes in children with cryptorchidism at different stages of treatment, select the necessary medications from its values and dynamically monitor the effectiveness of the treatment. It can be assumed that a higher information content of the proposed indices can be used in assessing the hemodynamics of other scrotal organ diseases.

Clinical example. Case history No. 123

Orlov V.I., 9 years old, was admitted to the urology department of the Children's hospital of Tver on March 11, 2003 with a diagnosis of cryptorchidism on the right, inguinal form. Before the operation, a comprehensive ultrasound examination of the scrotum organs was performed: the left testicle in the scrotum, sizes 32-14-17 mm, homogeneous structure, J - 1.358 (IR 0.69), the right testicle is visualized in the inguinal canal, sizes 22-11.5-13 mm, homogeneous structure, a small amount of liquid contents around the testis. J - 1.132 (IR 0.45). 03/13/2003, orchidopexy was performed according to Petrivalsky-Shemaker on the right. In the postoperative period, marked edema was noted on the side of the operation. On the 3rd day an ultrasound examination of the scrotum organs was performed: testicles in the scrotum, right testicle 25-14-16 mm, the structure is homogeneous, somewhat increased echogenicity. J on the right is 1.690, IR is 1.0, i.e. in terms of IR, it is impossible to objectively assess blood flow in the gonad. The left testicle - the size is the same, IGI - 1.237, IR - 0.60. High values of J indicate a high peripheral vascular resistance; therefore, antispasmodics are added to the standardized complex of therapy (physiotherapy, angioprotectors, antiplatelet agents, membrane stabilizers). On the 7th day after the operation, an ultrasound of the scrotum organs was performed in dynamics: the right testicle 23.5-14-16 mm, of a homogeneous structure. J - 1.093, IR - 1.0. The left testicle - the size and hemodynamic parameters are the same. March 21, 2003 the child was discharged in satisfactory condition, there is no swelling of the scrotum. At discharge, treatment is prescribed: membrane stabilizers, antiplatelet agents, angioprotectors. Three months later, a control ultrasound examination of the scrotum organs was performed: testicles in the scrotum, right testicle 23-12.5-14.7 mm, left testicle 32-14-19 mm, testicular structure homogeneous, J on the right - 1.188, IR - 0.50 . J on the left is 1.318, IR-0.68, which indicates the effectiveness of the treatment.

Claims (1)

A method for evaluating the intraorgan hemodynamics of the testicles in children with cryptorchidism by performing an ultrasound examination of the scrotum and determining as a result the peak systolic blood flow velocity V _CM and the final diastolic blood flow velocity V _D , characterized in that the blood flow is estimated using the integral hemodynamic index J according to the formula J = 1+ (J _C -J ₀₎ where J _C - the systole hemodynamic performance index, J _o - hemodynamic reverse flow index, the hemodynamic performance index chem ly calculated by the formula

where t _C - systole time, T _cc - period of the cardiac cycle, and hemodynamic index of reverse blood flow is calculated by the formula

where V _DM - minimum diastolic blood flow velocity, t _OK - time of reverse blood flow.