RU2271203C1 - Method for treating the syndrome of chronic pelvic pain caused by diseases of prostate and urinary bladder - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: one should rectally introduce medicinal cocktail of the following composition: 0.5%-Novocain 5 ml, halidor 2 ml, Dimexid 5 ml, and, additionally, perorally - berlithion 300 mg twice daily. The innovation suggested provides complex impact upon pain pathogenesis at the above-mentioned diseases, removes psychoemotional tension by, thus, improving patient's quality of life.

EFFECT: higher efficiency of therapy.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to urology. Chronic infectious and inflammatory diseases of the prostate gland and bladder - chronic prostatitis, cystitis, tuberculosis of the bladder and prostate gland often result in chronic pelvic pain syndrome (CFS). Sometimes it is called prostatalgia, prostatodynia in the literature, and cystalgia in the bladder. It is also possible the primary formation of SCTB, without a fixed previous inflammation.

CFS is characterized by constant exhausting pain in the perineum, above the womb, with irradiation in the genitals against the background of no signs of inflammation. APSB reduces sexual desire, promotes the development of sexual dysfunction (worsens an erection in men and causes dyspareunia in women), causes dysuria, including nightly urination. Nocturia does not allow the patient to rest, he wakes up in the morning not enough sleep and irritated, which interferes with his daily activities. Thus, without presenting an immediate threat to life, SKhTB significantly reduces its quality, which determines its not only medical, but also social significance.

The pathogenesis of CFS is not completely clear, therefore, there is still no clearly defined method of treatment for this disease. It was proposed the appointment of various physiotherapy, non-steroidal anti-inflammatory drugs, etc.

All these methods, as a rule, have an incomplete and short-lasting effect.

We have proposed a method for treating chronic pelvic pain syndrome caused by diseases of the prostate gland or bladder, medications, characterized in that the medicinal shake is administered rectally and additionally per os prescribe berlition 300 mg 2 times a day, and the medicinal cocktail is administered in the following composition: novocaine 0.5% -50 ml + halidor 2 ml + dimexide 5 ml.

We hypothesized that at the heart of SCTB are neurotrophic disorders, exacerbated by spastic discoordinated contractions of the detrusor and sphincter of the bladder. Based on these prerequisites, a therapeutic cocktail was compiled, which includes a halidor as an antispasmodic, which has a moderate sedative and analgesic effect, has a beneficial effect on microcirculation, and dimexide to ensure targeted delivery; at the same time, per os is prescribed berlition - oslipoic (thioctic) acid - “vitamin N”.

Chronic infectious and inflammatory diseases, including the prostate and bladder, lead to the formation of polyneuropathy, i.e. clinical condition due to degenerative-degenerative changes in the structure and corresponding dysfunctions of peripheral somatic (sensory and motor) and autonomic neurons. In this case, both the myelin sheath and the axons of the nerves are affected. Demyelination and axonal degeneration lead to a decrease in the rate of excitation along the nerve and, accordingly, to a violation of its function. The central mechanisms of polyneuropathy are two:

a) violation of energy metabolism, which plays a paramount role in the life of tissues and especially nervous;

b) increased free radical oxidation. As a result of energy deficiency, catabolic processes are activated, in particular protein catabolism. At the same time, the production of a powerful neurotropic poison, ammonia, is enhanced, which is opposed by the activity of pyridoxaldependent enzymes involved in the de- and transamination of amino acids and containing pyridoxalphosphate, the active form of vitamin B _6, as a prosthetic group.

α-lipoic (thioctic) acid, discovered in 1948 and proposed by the pharmaceutical industry for medical use under the name "Berlition", is an integral part of body cells that release energy by aerobic route. It affects energy metabolism, increases basic metabolism, has a cytoprotective effect by increasing antioxidant activity and stabilizing mitochondrial membranes; indirectly - shows anti-inflammatory and analgesic activity.

The standard treatment regimen for any polyneuropathy involves administering berlition intravenously or per os. Thus there is a systemic effect on the body; a positive effect on the symptoms of the prostate and bladder is also noted, but slightly.

The use of microclyster with halidor and dimexide simultaneously significantly improves both subjective and objective indicators, although monotherapy with microclysters also caused an insufficient effect. And only the combined use of microclysters with a medicinal cocktail and berlition can significantly increase clinical effectiveness and accelerate its manifestation. The use of halidor in a microclyster with dimexidum and berlition is pathogenetically justified in case of SCTB, since such a combination and method of drug administration provide relief of psychoemotional stress, improvement of neurotrophic and microcirculation, analgesic and antispasmodic effects.

The method is as follows.

After diagnosis, the patient is prescribed daily 300 mg of berlition 2 times a day + microclyster. The proposed method is based on the following recipe for a medical cocktail: novocaine 0.5% - 50 ml + halidor 2 ml + dimexide 5 ml. The cocktail is introduced into the rectum after an independent bowel movement; in the presence of persistent constipation, a cleansing enema is preliminarily carried out.

After the introduction of the cocktail, the patient is offered to be lying on his stomach for 30-40 minutes. A small amount of fluid, as a rule, does not cause stool. The course of treatment is 4 weeks.

Contraindication to the treatment is intolerance to one of the drugs, exacerbation of hemorrhoids, colorectal cancer, exacerbation of ulcerative colitis.

Example 1. Patient W., 24 years old, doctor. For 5 years, constant pain in the bladder area, aggravated by its filling, increased urination has been disturbing. Notes a decrease in sexual desire, sexual intercourse has become unpleasant. Urine holds well. 3 years ago she gave birth to a baby, during pregnancy, dysuria intensified and acquired a continuous character.

The onset of the disease is uncertainly associated with previous cystitis. Numerous courses of treatment, including a spa, were ineffective.

The patient is of proper physique, adequate nutrition. The genitals are formed correctly, the pathology during examination, palpation and ultrasound is not determined. Urine and blood tests are normal.

Cystoscopy: the urethra is clear. The bladder capacity is 200 ml, the mucosa is pale pink. The mouths of the slit-shaped form are located symmetrically in typical places. A biopsy of the bladder wall was performed; pathomorphologically - signs of chronic nonspecific inflammation with severe malnutrition of tissues.

Prescribed treatment: daily at night microclysters (novocaine + halidor + dimexide) in combination with per os berlition 300 mg twice a day.

Control examination after 2 weeks: the patient became calmer, nocturia decreased from 4 to 1 urination, which allowed the patient to get enough sleep and accordingly improved her mood. The pain is significantly reduced.

Inspection after 4 weeks: no complaints. The pain syndrome was completely stopped, the number of urination decreased to 6-7 per day.

Example 2. M., 42 years old, engineer. More than 10 years ago he underwent urogenital chlamydia, 7 years ago he was diagnosed with Chronic nonspecific bacterial prostatitis (growth of Escherichia coli and Staphylococcus aureus was obtained in prostate secretion). After complex antibacterial therapy, the eradication of infectious agents was achieved, however, the patient was still worried about pain in the perineum, giving into the testicles, decreased erection, periodically - increased urination.

In rectal examination, the rectal ampoule is free, the prostate is flattened, its tone is reduced, the groove is smoothed. Palpation is moderately painful. Secret microscopically of leukocytes of 20-25 in the field of view, the number of lecithin grains is reduced, there are no bacteria.

Prescribed treatment: daily at night microclysters with halidor and dimexide, twice a day - 300 mg berlition.

Examination after 2 weeks: the intensity of pain decreased significantly, interest in sexual activity appeared.

Inspection after 4 weeks: no complaints, resumed regular sex life; palpation of the prostate gland is painless, the number of leukocytes in the smear decreased to 6-8 in the field of view.

The method was tested in the urogenital department of the Research Institute of Tuberculosis of the Ministry of Health of the Russian Federation in 12 patients. The effectiveness of treatment was determined according to the following criteria: pain intensity — patients independently evaluated the intensity of pain on a 5-point scale (0 - no pain; 5 - unbearable pain, requires painkillers).

Daily urination rate

Urinary Frequency

Quality of life - on a 5-point scale (0 - quality of life is very poor, 5 - very good).

The quality of sexual life is on a 5-point scale (0 - quality of life is very poor, 5 - very good).

The results are presented in the table.

Table.
The effectiveness of the treatment of CPSB by the proposed method. signs initially after treatment Pain (points) 4.2 1,1 Daily urination rate 8.25 5.8 Urinary Frequency 2.7 0.7 Quality of sex life 2,5 4.2 The quality of life 2.6 4.1

Based on the table, we can conclude that the inventive method of treating chronic pelvic pain syndrome caused by diseases of the prostate gland or bladder can reduce the frequency of daytime urination by 30%, and nighttime - almost 4 times; improve the sex life of patients and, in general, improve their quality of life. The method is highly effective and can be applied in the clinical practice of a urologist both on an inpatient basis and on an outpatient basis.

Claims (1)

A method of treating chronic pelvic pain syndrome caused by diseases of the prostate gland or bladder, drugs, characterized in that as drugs use novocaine 0.5% -50 ml, halidor 2 ml, dimexide 5 ml in the form of a drug cocktail, which is administered rectally, and additionally orally administered berlition 300 mg 2 times.