RU2475241C1 - Method of treating acute orchiepididymitis and their complications - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely urology, and may be used for treating acute orchiepididymitis and their complications. With underlying antibacterial therapy, a local therapy is applied. That is ensured by localising a spermatic cord on the border between a scrotum and an external inguinal ring, fixing it with fingers to perform local anaesthesia with 0.5% Novocaine 1-2 ml to create an infiltration round. Thereafter, a needle is pushed forward in a proximal direction, and recombinant interleukin-2 500000 IU 2 ml with 0.5% Novocaine 40 ml is introduced.

EFFECT: invention enables reducing a number of complications and provides more complete recovery of testicular and epididymis functions ensured by cicatrisation prevention.

1 ex

Description

The invention relates to medicine, in particular to urology, and can be used to treat acute orchoepididymitis and their complications.

One of the most common genital diseases in men is epididymitis, diagnosed in 80-90% of cases (G.S. Grebenshchikov, S.I. Shevtsov, 1970). Orchitis can pathogenetically either precede epididymitis (B.S. Gehman, 1963), or it can be a complication of the latter (O.L. Tiktinsky, 1990). In the literature, the combination of orchitis and epididymitis is described by equivalent nosological concepts: orchiepididymitis, or epididyimorchitis. The main nosological form to which the claimed method relates is epididymitis, which determines the choice of analogues and prototype of the invention.

There is a method of treating acute epididymitis by surgical epididymotomy in the longitudinal and transverse directions, with drainage of the scrotum (R. Witherington, W.M. Harper, 1982).

The disadvantage of this method is trauma. Long recovery and rehabilitation.

There is a method of treating orchoepididymitis by percutaneous infiltration of the spermatic cord with procaine hydrochloride solution (DESmith, 1941). The author used 10-20 cm ^{3 of a} 1% solution of procaine hydrochloride as a single injection.

The disadvantage of this method is the lack of antibacterial action, a local reaction to the administered drug is possible. The development of funicular, possibly the development of an abscess in the future.

A known method of treating acute nonspecific epididymitis with a combination of aspirin 10 g once a day, tetracycline 250 mg × 4 times a day and the proteolytic enzyme streptokinase (varidase) at a dose of 10,000 units per day with its intramuscular injection, or in the form of absorbable tablets in the mouth (Tiktinsky O. L. "Andrology", 1999, pp. 67-68).

The disadvantage is the lack of local anti-inflammatory treatment. Prolonged pain in the testicle. Longer duration of treatment.

A method of treating orthoepididymitis according to U.A. Ishanhodzhiev (Lymphatic therapy in surgery. - Tashkent, 1991, p. 226-232) is that after processing the skin of the scrotum in the area of the outer surface of the testicle and after intradermal anesthesia, the needle was moved deeper in the direction the testicle is not perpendicular, but at an acute angle until it reaches its albumen, without piercing it. In this position, 2.5 ml of the lymphostimulator trypsin, chymotrypsin diluted in 35 ml of isotonic sodium chloride solution or distilled water are injected; without changing the needle, after 25 minutes an antibiotic was injected in a dose of 1/4 - 1/2 of the standard daily intake. The procedure is performed 1 time per day for 3-5 days.

The disadvantage of the method of treatment of orchoepididymitis is that it does not take into account the features of the lymphatic outflow from the testis and appendage in conditions of inflammation. Existing methods for lymphatic therapy of orchoepididymitis, including the introduction of drugs into the scrotum cavity, do not ensure the accumulation of an antibiotic and lymphostimulator both in the system of superficial (from the scrotum walls) and in the system of deep lymph nodes (from the testis and appendage), which increases the number of complications (irreversible violation of spermatogenesis, obstruction of the vas deferens, hormonal disorders), which leads to incomplete restoration of testicular and appendage function. Perhaps the development of a chronic process in the tissue of the testis and appendage against a background of an inadequate immune response, the absence of immunocorrection and immunoprophylaxis in the usual treatment.

The closest is a method of treating orthoepididymitis by regional lymphatic therapy, including piercing the testicle with a needle and introducing lymphostimulants and antibiotics into the tissues (Patent RU 2074716, IPC A61K 31/245, publ. 03/10/1997). As a lymphostimulant, novocaine is used, which is administered simultaneously with an antibiotic, first the upper pole of the testis is injected, then the head of the appendage, the transitional fold between the testis and appendage, these organs are infiltrated in equal portions of the drug mixture 1 ml each, and the remaining 3 ml of the solution are injected into the syringe cavity of the scrotum.

With the sequential introduction of the novocaine lymphostimulator in a mixture with an antibiotic, the latter is less absorbed by the roots of the lymphatic channel, since its links are already crowded and the patency of the regional lymph nodes is impaired.

The method is traumatic, violation of the integrity of the tissue of the testis and appendage exacerbates further inflammation.

The claimed invention is aimed at solving the problem of creating a method for the treatment of orthoepididymitis and its complications, in which due to the simultaneous administration of lymph and immunostimulant, a more complete restoration of the functions of the testicle and its appendage is provided, the number of complications is reduced.

The problem is solved by the method of treatment of acute orchiepididymitis and their complications, by antibiotic antibiotic therapy and regional therapy, including the introduction of a novocaine lymphostimulator into the scrotum. To do this, find the spermatic cord on the border between the scrotum and the external inguinal ring, fix it with your fingers, conduct local anesthesia of 1-2 ml of 0.5% novocaine, creating an infiltration roller, after which, advancing the needle in the proximal direction, inject 2 ml into the spermatic cord recombinant interleukin-2 500,000 IU with 40 ml of 0.5% novocaine.

The novelty of the invention:

Find the spermatic cord at the border between the scrotum and the external inguinal ring, fix it with your fingers, perform local anesthesia of 1-2 ml of 0.5% novocaine, creating an infiltration roller, then the needle is advanced in the proximal direction, 2 ml of recombinant interleukin is inserted into the spermatic cord 2,500,000 IU with 40 ml of 0.5% novocaine.

Comparative analysis with the prototype allows us to conclude that the claimed method of treatment differs from the known one by the simultaneous administration of a lymphostimulator and local-area cytokine therapy in the testis, epididymis, surrounding tissues, regional lymph nodes, due to the introduction of the mixture into the spermatic cord.

The proposed place of introduction of the mixture of drugs and their quantity ensures their bringing to the regional lymph nodes of the testis, epididymis and walls of the scrotum, taking into account the different ways of lymphatic outflow from the organs of the scrotum and its walls.

Thus, the claimed technical solution meets the criterion of "novelty."

The set of essential features of the invention allows to obtain a new technical result:

- carry out general immunocorrection;

- increase the effectiveness of the fight against infection;

- reduce the number of complications;

- conduct a more complete restoration of the functions of the testis and its appendage;

- the method prevents the transition of the disease into a chronic process;

- the formation of scar tissue in the testicular tissue is prevented.

With the simultaneous administration of the novocaine lymphostimulator and local local-area cytokine therapy with the recombinant interleukin-2 drug, an effect on the cellular and local immunity of the tissue occurs. Cytokine therapy has a detoxifying effect and immunocorrective effect.

In the future, normal regulation of the immune response is restored, tolerance is overcome, and the ability to prevent further autoimmune complications appears.

The method is as follows.

Antibiotic therapy is performed. After treating the skin of the scrotum with an antiseptic on the side of inflammation, the organs of the scrotum are determined by palpation: testicle and appendage. Palpation of the spermatic cord on the border between the scrotum and the external inguinal ring, fix it with your fingers. The scrotum skin is anesthetized with 2 ml of 0.5% novocaine, creating an infiltration roller. After that, without removing the needle, attach to it a syringe filled with a mixture of drugs. Advancing the needle in the proximal direction, 40 ml of 0.5% novocaine with 2 ml of recombinant interleukin-2 500,000 ME are introduced into the spermatic cord.

An example of the method.

Patient Golovkov I.S. 35 years old, was admitted to the urology department 03/29/2011 with a diagnosis of acute right-sided orthoepididymitis. Complaints of pain and swelling of the scrotum on the right, itching when urinating, weakening erection. Anamnesis: prescription of the disease - two days ago. Objectively: temperature 37.5 ° C, pulse 100 beats per minute. Blood pressure 120/80 mm Hg

In the right half of the scrotum, an enlarged and painful epididymis is palpated, scrotal edema from the affected side. The spermatic cord is not thickened. The left testicle and appendage are not changed.

Taken on 03/29/11, OAK, on which leukocytosis up to 10 / mm ³ , lymphocytes 1-63 / mm ³ , lymphocytes 12%.

Ultrasound of the scrotum organs from 03/29/11: no ulcers were detected. The right testicle is 38 * 24 mm, the left is 37 * 18 mm. Echogenicity of the right testicle is increased. The epididymis on the right is thickened, reduced echogenicity, the thickness of the appendage in the tail region is up to 12 mm. Slightly, in the shells on the right there is an anechogenic effusion (ultrasonic sign).

An ejaculate was taken with a cultural study: severe pathospermia, sperm count of 20 million, viscosity with purulent pieces, white blood cells up to 40 in the field of view. In the epithelium, pronounced granularity, cytoplasm dystrophy. Flora: cocci grams are negative, a lot in sight, the number of sperm is small.

The antibioticogram revealed the sensitivity of concomitant microflora, seeded from the patient urethral scraping and ejaculate, to cefataxime. An immunogram on which a decrease in the t-cell and phagocytic link. Helper T-CD4, CD3 44%. The number of active phagocytes is 1.29 ⁹ / L.

Taking into account the preliminary examination, the patient was prescribed antibacterial therapy. After preparation, March 30, 2011, treatment was carried out according to the proposed method.

Execution technique:

In aseptic conditions. Antiseptic treatment of the surgical field 2 times. Palpation of the spermatic cord on the border between the scrotum and the external inguinal ring, fix it with your fingers. The scrotum skin is anesthetized with 2 ml of 0.5% novocaine, creating an infiltration roller, connected with a Luer syringe with a thin needle. After that, advancing the needle in the proximal direction, 2 ml of recombinant interleukin-2 500000 IU with 40 ml of 0.5% novocaine are introduced into the spermatic cord.

The procedure was carried out once.

An aseptic patch is applied to the injection site.

Given the seeding of the ejaculate, the antibacterial drug cefotaxime 1.0 was prescribed 2 times a day, for five days.

The painful sensations that accompanied the injection disappeared in the patient after 10 minutes. Swelling of the scrotum disappeared in the next 1.5 hours. On the 2nd day after the start of treatment, the patient's condition improved: the pain, swelling in the scrotum, and itching during urination disappeared. On 2-3 days, body temperature returned to normal.

According to the ultrasound examination of the scrotum organs, the swelling of the testicle and the thickness of the appendage decreased, the effusion on the third day disappeared. A control study of the ejaculate was performed 2 weeks after the start of treatment on 04/11/2011; the amount of 4.0 ml; the color is milky white, the smell is normal, the pH is alkaline, liquefaction after 67 minutes; sperm compliance: normokinetic 89%, hypokinetic 6%, akinetic 5%, pathological forms 4%, sperm count in the ejaculate 416 million (104 million / ml); there are no spermatogenesis cells; there are no white blood cells.

On the fifth day, an immunogram on which an increase in the t-cell and phagocytic link. Helper T-CD4, CD3 - 54%. The number of active phagocytes increased to 3.20 ⁹ / L. The number of CEC 33 units

In the general analysis of blood on the 5th day, a decrease in leukocytosis, in the formula of leukocytes 5.8 mm ³ / mm ³ , an increase in lymphocytes 26%.

Thus, as a result of the treatment, an etiological and clinical recovery occurred. Blood counts improved, immunological status and spermatogenesis were restored. The ultrasound picture shows the absence of scar tissue in the testis parenchyma against the background of this treatment. The patient leads a normal social and sexual life.

The proposed method treated 9 patients.

The claimed "Method for the treatment of acute orchoepididymitis and their complications", including local-area cytokine therapy in combination with the lymphostimulator novocaine and antibacterial therapy, is more effective than previously used methods, since with 99% etiological extraction of orchiepididymitis in the clinic, it also improves spermatogen immunogenesis status of patients with orthoepididymitis.

The method allows to reduce the duration of the pathological process in the testis and epididymis, as well as surrounding tissues, to prevent the development of inflammation, and to restore the immune status.

Claims (1)

A method of treating acute orchoepididymitis and their complications by antibiotic antibiotic therapy and regional therapy, including the introduction of a novocaine lymphostimulator into the scrotum region, characterized in that the spermatic cord is palpated at the border between the scrotum and the external inguinal ring, fixed with his fingers, 1-2 local anesthesia is performed ml of 0.5% novocaine, creating an infiltration roller, after which the needle is advanced in the proximal direction, 2 ml of recombinant interleukin-2 500000 ME with 40 are introduced into the spermatic cord l 0.5% novocaine.