RU2371182C1 - Method of urolithiasis recurrence treatment and prevention for men - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly urology and urolithiasis recurrence prevention and treatment for men. General testosterone level in blood serum of all men is determined preliminarily. If androgenic deficiency is detected, patients not suffering from prostate cancer are treated with any available testosterone medicine, additionally to standard therapy: Androgel - 5 g externally daily, Nebido - 4 ml intramuscularly one time in 3 months, Sustanol-250 - 1 ml intramuscularly one time in 3 weeks, Omnadren-250 - 1 ml intramuscularly one time in 4 weeks. In the course of therapy, medicines can be changed or alternated. Minimum course comprises 3 months. Treatment is implemented with account of general testosterone level in blood serum, which should exceed 12 nmol/l. Therapy efficiency is indicated by increased or stabilised level of mineral density of osseous tissue by T and Z criteria determined by densitometry, and by the absence of stone formation recurrence confirmed clinically and by ultrasonic kidney scanning.

EFFECT: ethiopathogenetic effect on stone formation process, resulting in recurrence-free course of urolithiasis for 1-1,5 years.

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Description

The invention relates to medicine and is used in the treatment of men suffering from urolithiasis (urolithiasis), as well as for the prevention of relapses of re-stone formation.

Known methods of treating urolithiasis, which are aimed at removing stone from the urinary system, i.e. act on the secondary manifestation of urolithiasis - a stone, and not on the root cause of stone formation. These are such treatment methods as remote shock wave lithotripsy, endoscopic contact lithotripsy, ureteroscopy with lithoextraction, various methods of surgical interventions on the kidneys and urinary tract, which are discussed in the Guide to Urology. / Ed. N.A. Lopatkina. - In 3 volumes. - T.2. - M .: Medicine, 1998 [1], as well as in other basic urological publications [2, 3, 4, 5].

The objective of the invention is to increase the effectiveness of treatment of urolithiasis, as well as the prevention of its recurrence.

Urolithiasis is a chronic polyetiological disease. The literature describes many different causes of stone formation, however, in the practice of a urologist, when determining the possible causes of stone formation in a particular patient, the percentage of known causes is extremely small.

In the urological clinic of the Omsk State Medical Academy (Supervisor is the author and applicant, associate professor P.I. Shuster) on the basis of the urological department of the Omsk Regional Clinical Hospital, over 5 years from 2003 to 2007, 1,173 men suffering from urolithiasis (urolithiasis) were treated.

The causes of stone formation in men and women are different. Based on sufficient clinical material, we determined that the vast majority of urolithiasis in men occurs at the age of 40-70 years (the average age of patients with urolithiasis is 50.6 years) - the age of the maximum manifestation of age-related androgen deficiency, which leads to a decrease in bone mineral density and leakage of calcium from the bones. A pathogenetic relationship between age-related androgen deficiency through osteopenia and urolithiasis in men has been proven.

Serum testosterone levels were determined for all men with urolithiasis to diagnose age-related androgen deficiency and densitometry was performed to determine bone mineral density. Age-related androgen deficiency was detected in 71.3% of patients, and a decrease in bone mineral density in the form of osteoporosis, osteopenia, or a tendency to osteopenia - in 85% of patients.

The method for the treatment and prevention of recurrence of urolithiasis in men differs in that the method of drug therapy using androgens does not affect the stone - the main, but secondary manifestation of urolithiasis, but on the root cause of stone formation in men. Those. this treatment and prevention of stone formation are purely etiopathogenetic.

The method is as follows.

A patient with urolithiasis after exclusion of contraindications (mainly exclusion of prostate cancer - serum PSA, digital rectal examination and prostate TRUS) is prescribed one of the existing dosage forms of testosterone:

- Androgel - 5 g of gel containing 50 mg of testosterone, externally, daily;

- Nebido - 4 ml intramuscularly containing 1000 mg of testosterone, 1 time in 3 months;

- Sustanon-250 - 1 ml intramuscularly, containing 250 mg of testosterone esters, 1 time in 3 weeks;

- Omnadren-250 - 1 ml intramuscularly, containing 250 mg of testosterone esters, 1 time in 4 weeks.

In this case, a change and alternation of various dosage forms of testosterone is possible.

The minimum course of treatment is 3 months.

Control and Efficiency Criteria:

- normal level of total testosterone in blood serum (more than 12 nmol / l);

- increase or stabilization of the level of bone mineral density (T- and Z-criteria for densitometry);

- the absence of recurrence of stone formation, clinically confirmed by ultrasound scanning of the kidneys (ultrasound of the kidneys).

Preliminary studies on 80 volunteer patients showed the high efficiency of the proposed method for the treatment and prevention of urolithiasis in men.

The studies were carried out in the urological department of the Omsk Regional Clinical Hospital - the main clinical base of the Omsk State Medical Academy.

Example 1. Patient L., 59 years old, suffers from urolithiasis for about 12 years. Diagnosis: Bilateral multiple recurrent urolithiasis.

History: 18 sessions of distance lithotripsy (DLT) on the right at different times for 5 years for recurrent stones and multiple episodes of self-discharge of calculi. Then transferred pyelolithonephrostomy, decapsulation and excision of the carbuncle of the right kidney with purulent-destructive right-sided pyelonephritis against the background of multiple stones of the right kidney and stone of the right ureter. A year later, a nephrectomy on the right with multiple recurrent stones of the right kidney and pyonephrosis. Six months later, three subsequent sessions of DLT stones of a single left kidney. Multiple independent passage of calculi on the left. The last hospitalization in an emergency room with an attack of left-sided renal colic with a single left kidney. During the examination (laboratory examination, ultrasound scanning, excretory urography), a recurrent stone of the upper third of the left ureter, left-sided obstructive pyelonephritis of the only left kidney with pronounced retention of the pyelocaliceal system were diagnosed. The patient underwent percutaneous puncture nephrostomy (NPNS) on the left, subsequently - DLT of the stone of the upper third of the left ureter with fragmentation and discharge of the stone.

The patient is diagnosed with age-related androgen deficiency - total testosterone in blood serum 6.37 nmol / L. Densitometry revealed osteoporosis (criterion T: -3.7, criterion Z: -3.1). The level of prostate-specific antigen (PSA) is normal (1.8 ng / ml). Two courses of androgen replacement therapy were carried out using AndroGel - 5 g externally (50 mg testosterone) daily for three months and Sustanon-250 - 1 ml intramuscularly (250 mg testosterone esters) once every 3 weeks. The level of total testosterone is kept at 18 nmol / l, an increase in bone mineral density is observed (criterion T: -1.6; criterion Z: -1.3 - while at the level of osteopenia). After performing antegrade pyelography on the left, the nephrostomy of the only left kidney was removed. Observation during the year is a relapse-free course of urolithiasis.

Example 2. Patient P., 48 years old, suffers for 5 years with bilateral recurrent urolithiasis. A history of 3 sessions of DLT of kidney stones (two on the right, one on the left) and regular independent discharge of calculi on both sides with a frequency of once every 1.5-2 months.

Diagnosis: Bilateral recurrent urolithiasis.

Eliminating all previously known etiological factors of stone formation, the patient revealed age-related androgen deficiency. The level of total testosterone is 8.35 nmol / L. Densitometry indices: T criterion: -2.2; Criterion Z: -1.9. Diagnosed with osteopenia.

The patient is prescribed androgen replacement therapy: Androgel - 5 g of gel externally, daily. Follow-up examinations after 3, 6, 9, 12 months showed: normalization of the level of total testosterone (17-24 nmol / l), increase in bone mineral density (there is a slight tendency to osteopenia), kidney ultrasound and clinical observation - for one and a half years, relapse-free course of urolithiasis.

Information sources

1. Guide to urology. / Ed. N.A. Lopatkina. - In 3 volumes. - T.2. - M .: Medicine, 1998 .-- 768 p.

2. Tiktinsky O.L. Urolithiasis - L .: Medicine, 1980.

3. Urology. / Ed. Yu.G. Alyaeva. - M.: “Medical News Agency”, 2005. - 640 p.

4. Dzeranov N.K. Remote shock wave lithotripsy of urolithiasis: Author's abstract. Dis ... Doct. - M., 1994 .-- 34 p.

5. Dedov I.I., Kalinchenko S.Yu. Age-related androgen deficiency in men. M., 2006 .-- 240 p.

Claims (1)

A method for the treatment and prevention of recurrence of urolithiasis in men, including the use of drugs, characterized in that in addition to patients without prostate cancer, any of the available dosage forms of testosterone is prescribed: Androgel - 5 g of gel containing 50 mg of testosterone externally, daily, Nebido - 4 ml intramuscularly containing 1000 mg of testosterone once every 3 months, Sustanon-250 - 1 ml intramuscularly containing 250 mg of testosterone esters once every 3 weeks, Omnadren-250 - 1 ml intramuscularly containing 250 mg of ether in testosterone once every 4 weeks, while the change and alternation of drugs is possible, they focus on normalizing the level of total testosterone in the blood serum, the level of which should be more than 12 nmol / l, increasing or stabilizing the level of bone mineral density by T- and Z- criteria for densitometry, the absence of recurrence of stone formation, clinically confirmed and with ultrasound scanning of the kidneys, the minimum course of treatment is 3 months.