RU2261716C1 - Method for prophylaxis of suppurative-inflammatory complications in patients with benign prostate hyperplasia in post-operative period - Google Patents

Abstract

FIELD: medicine, surgery, urology.

SUBSTANCE: method involves administration of hypochlorite sodium in the concentration 0.004% that is combined with its intra-bladder administration in the concentration 0.06% in pre-operative and post-operative periods. Invention promotes to complete sanitation of urinary ways for the shortest time after surgery of transurethral resection of prostate. Invention can be used in prophylaxis of suppurative-inflammatory complications in patients with benign prostate hyperplasia in post-operative period.

EFFECT: improved method for prophylaxis.

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Description

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

A known method for the prevention of purulent-inflammatory complications in patients with benign prostatic hyperplasia after its transurethral resection, which consists in indirect electrochemical oxidation of blood by intravenous administration to patients in the preoperative period of 0.06% sodium hypochlorite solution (Kamalov A.A., Danilkov A.P., Shakir F.I. et al. "Indirect electrochemical oxidation of blood in the prevention of purulent-inflammatory complications after transurethral resection of the prostate" Urology No. 4, 2003, p.30-32). This method is taken as a prototype.

The disadvantage of this method is the use of a high concentration (0.06%) of sodium hypochlorite, which can cause phlebitis, venous necrosis, the formation of paravenous infiltrates, damage to blood cells, up to the development of hemolysis. Therefore, the intravenous administration of high doses of sodium hypochlorite is limited by the risk of serious complications and a large list of contraindications, especially in older men.

Object of the invention: To increase the effectiveness of prevention of postoperative purulent-inflammatory complications in patients with benign prostatic hyperplasia, using sodium hypochlorite for indirect electrochemical oxidation of the blood and irrigation of the bladder.

The task is achieved by the use of sodium hypochlorite for intravenous administration of a low concentration in combination with the intravesical administration of this drug of a higher concentration in the preoperative and postoperative period without antibacterial therapy.

The method is as follows.

After a clinical examination, patients with benign prostatic hyperplasia within 2 days before surgery are injected intravenously with a solution of sodium hypochlorite at a concentration of 0.004% at the rate of 10 ml per kilogram of weight, in combination with intravesical administration at a concentration of 0.06% 400 ml 1 time per day in the presence of epicystostomy. In the postoperative period, sodium hypochlorite is used according to this scheme until the catheter is removed from the bladder (3 days). Antibacterial therapy in the pre- and postoperative period is not carried out.

An example of a specific application: Example No. 1. Patient G., 78 years old, was admitted to the urology department for planned surgical treatment for an accident. From the anamnesis it was revealed that 1 month ago he treated with acute urinary retention in the hospital’s emergency room. At that time, urine was removed by a catheter, refused the proposed hospitalization. He entered the direction of a urologist at the clinic. Upon receipt, urination with a sluggish stream marks a pain at the end of urination. In urinalysis, leukocyturia up to 20 in the field of view, urine culture - bacteriuria more than 10 ⁵ CFU / ml, in the prostate secret 15 leukocytes in the field of view. Rectal digital and ultrasound examination of the prostate indicate an increase in it. Total score I-PSS S = 20, quality of life L = 4. In the immunogram, immunosuppression is 3 degrees.

Within two days before the operation, a 0.004% sodium hypochlorite solution in the amount of 800 ml once a day was dripped into the ulnar vein.

On the day of surgery, urine was examined, in the analysis of which a decrease in the number of leukocytes to 7 in the field of view was noted, urine culture did not give urine culture for sterile growth. In the analysis of prostate secretion, the number of leukocytes decreased to 5 in the field of view.

After transurethral resection of the prostate, intravenous administration of sodium hypochlorite of 0.004% 1 time per day was continued and the installation of the bladder with a 0.06% sodium hypochlorite solution of 400 ml 2 times a day was started. This treatment lasted three days (until the removal of the urethral catheter). The independent act of urination was restored, there are no complications at the site of intravenous administration of sodium hypochlorite solution. Before discharge urine culture - no bacteriuria. At discharge, the total score I-PSS S = 9, quality of life L = 2. The total bed day was 5 days. During the period of stay in the hospital, antibiotic therapy was not carried out.

Example No. 2. Patient 3., 74 years old. He entered the urology department with a diagnosis of accident, epicystostomy. Epicystostoma was imposed 3 months ago for acute urinary retention. The second stage of the operation was twice delayed due to the pathology of the cardiovascular system. Upon receipt, do not urinate on your own. Urine separated by fistula is cloudy with purulent sediment. In a general urinalysis, white blood cells cover all fields of vision. Sowing urine for sterility gave the growth of E. coli more than 10 ⁶ CFU / ml. According to the immunogram - immunosuppression of 3 degrees. The total score of I-PSS preceding epicystostomy S = 30, quality of life L = 5. In order to prevent postoperative complications before surgery, the patient was injected intravenously with a 0.004% sodium hypochlorite solution at a rate of 10 ml / kg once a day for two days and an bladder instillation with a 0.06% sodium hypochlorite solution 400 ml 1 time per day through an epicystostomy .

Tests were taken on the day of surgery, white blood cells in urine 10-15 in the field of view, urine culture for sterility - bacteria growth of less than 10 ⁵ CFU / ml was obtained. After the TUR of the prostate, the patient continued with intravenous administration of sodium hypochlorite in combination with intravesical administration, at the dosages indicated above, for three days before removal of the drainage from the bladder. After removal of the drainage, an independent act of urination was restored, and the patient was discharged for outpatient observation without leukocyturia and bacteriuria. Antibiotic therapy was not performed for the patient. At discharge, the total symptom score I-PSS S = 10, quality of life L = 1, purulent-inflammatory complications in the patient in the postoperative period was not noted.

Thus, intravenous administration of sodium hypochlorite in combination with intravesical administration in the pre- and postoperative period effectively sanitizes the urinary tract, prevents the development of purulent-inflammatory complications in the postoperative period, and reduces the length of the patient’s hospital stay. The use of a 0.004% sodium hypochlorite solution for intravenous administration avoided the specific complications of this treatment method.

Claims (1)

A method for the prevention of purulent-inflammatory complications in patients with benign prostatic hyperplasia, including intravenous administration of sodium hypochlorite in the preoperative period, characterized in that intravenous administration of sodium hypochlorite at a concentration of 0.004% is combined with intravesical administration at a concentration of 0.06% in the preoperative and postoperative period.