RU2457792C1 - Method of endoscopic correction of vesicoureteral reflux - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to urology. Solution of collagen is introduced by means of endoscopic puncture needle, with formation of external bolus. Synthetic material is introduced into the centre of formed collagen bolus.

EFFECT: method ensures efficient and safe endoscopic correction of vesicoureteral reflux.

1 ex, 6 dwg

Description

The invention relates to medicine, in particular to urology, and can be used for endoscopic correction of vesicoureteral reflux in children and adults.

A known method of endoscopic correction of vesicoureteral reflux, based on the introduction of fixing substances under the mouth of the ureter, while synthetic materials, for example, Teflon (Lopatkin N.A., Chepurov A.K., Nemenova A.A. Antireflux the introduction of Teflon paste in patients with vesicoureteral reflux // Endoscopic surgery and distance lithotripsy. - Moscow, 1992, S.25-29).

The disadvantage of this method is the relatively low efficiency of correction of vesicoureteral reflux, due to the fact that the synthetic materials used are dangerous in use, because are a carcinogen and, when used, there is a risk of vascular migration of the drug into vital organs: the brain, liver, and lungs. Uterine stenosis at the injection site of the fixative is also possible.

There is also known a method of endoscopic correction of vesicoureteral reflux, in which collagen is used as a fixing substance (Haferkamp A., Mohring K. et al. Pitfalls of reped subureteral boving collagen injection for the endoscopic treatment of vesicoureteral reflux. J. Urology 2000; 163 Urology 2000; 163 (6): 1919-1921.).

The disadvantage of this method is its relatively low efficiency, due to the fact that due to the frequent recurrence of reflux, collagen has to be administered twice or three times. Since the substance is of animal origin, the development of an immune reaction to its introduction is possible.

The closest technical solution for the totality of essential features is a method for endoscopic correction of vesicoureteral reflux, including the introduction of an endoscopic needle under the mouth of the affected ureter at 6 o’clock on the conditional dial and the introduction of a synthetic gel through the needle, forming a submucous bolus until the gaping mouth of the ureter closes (RF patent No. 2148957, class А61В 17/00 dated 05/20/2000).

The disadvantage of the method according to patent No. 2148957 is that its use does not prevent the migration of synthetic materials, which does not provide the required safety for the use of any injection polymers.

The problem to which the claimed invention is directed, is to increase the efficiency of endoscopic correction of vesicoureteral reflux.

The problem is solved due to the fact that in the method of endoscopic correction of vesicoureteral reflux, including the introduction of synthetic material under the mouth of the ureter with the formation of an external bolus, a collagen solution is injected before the synthetic material is introduced, forming an external bolus, and the synthetic material is introduced into the center of the formed collagen bolus .

Figure 1-5 presents illustrations of the method of endoscopic correction of vesicoureteral reflux.

Figure 6 presents a General view of the endoscopic puncture needle, where 1 is the outer needle, and 2 is the inner needle, 3 is the mandrin.

The method of endoscopic correction of vesicoureteral reflux is as follows.

After the cystoscope is inserted into the cavity of the bladder, an external needle 1 is inserted through its working channel and an injection is made under the mouth of the affected ureter at 6 o’clock on the conditional dial (Fig. 1).

Collagen 4 is introduced along the outer needle, forming a submucosal bolus closing the gaping mouth of the ureter (Fig. 2). Then, the inner needle 2 is introduced into the lumen of the outer needle 2 with the mandrel 3 pre-installed in it (Fig. 3). After removal of the mandrel on the inner needle 2 is introduced synthetic material 5, after which both needles are removed (figure 5). Due to the fact that the inner needle is longer than the outer one, the implantable synthetic material is localized in the center of the formed collagen bolus (Fig. 5), which prevents the hydrogel from flowing out of the injection site, migrating it into the surrounding tissues, as well as moving the synthetic material along the Waldeer shell to the side wall of the detrusor . The ratio of the volume of injected collagen implants: synthetic material is 3: 1.

A clinical example of using the method of endoscopic correction of vesicoureteral reflux.

Patient B., 4 years old, was admitted to the 10th surgical department of Moscow City Children's Clinical Hospital No. 9 for treatment with a diagnosis of bilateral third-degree vesicoureteral reflux, chronic pyelonephritis, recurrent course.

History: severe urinary syndrome in the form of persistent leukocyturia and microhematuria. Over the past year, three exacerbations of pyelonephritis with hypothermic syndrome and severe symptoms of intoxication.

Given the recurrent course of pyelonephritis and a severe degree of reflux, the child was shown endoscopic correction of vesicoureteral reflux on both sides.

Endoscopic intervention was performed under general anesthesia.

The submucosal layer of the left mouth was injected with an external needle at 6 o’clock on the conditional dial, a collagen solution manufactured by MIT (Russia) was injected with a needle and a bolus was formed until the ureter mouth closed. The volume of injected collagen was 1.5 ml. Next, an inner needle was inserted into the lumen of the outer needle with the mandrin installed in it. After removal of the mandrel, 0.5 ml of Urodex synthetic material was introduced into the inner needle, after which both needles were removed. When monitoring the injection site, no hydrogel leakage was noted. Collagen fibers were determined at the puncture site of the mucosa; there was no bleeding.

In the early postoperative period, with a visual examination of the patient's urine, after the first urination, the presence of hydrogel microparticles in it was recorded.

An ultrasound examination of the volume of boluses created, carried out the day after the intervention, was noted: on the right, the bolus volume was 0.3-0.4 ml, 1.5 ml on the left, of which 1 ml was collagen and 0.5 ml was a hydrogel located in the center of a bolus.

In satisfactory condition, the child was discharged home on the same day. Three months after the operation, during ultrasound monitoring of bolus volumes, it was noted: the bolus is not determined on the right, the hydrogel bolus is determined on the left with a volume of 0.4-0.5 ml, collagen is not visualized. Around the hydrogel, the fibrous capsule with a wall thickness of 1-2 mm is clearly differentiated. On the control cystogram, reflux was not detected on both sides.

Claims (1)

A method for endoscopic correction of vesicoureteral reflux, including the introduction of synthetic material under the mouth of the ureter with the formation of a bolus, characterized in that before the introduction of synthetic material, a collagen solution is injected, forming an external bolus, and the synthetic material is introduced into the center of the formed collagen bolus.

Images