RU2605624C1 - Method of treating detrusor overactivity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology, and concerns treating detrusor overactivity. Method involves cystoscopy with filling bladder with solution of nitrofural with subsequent injection of solution of botulinum toxin type A directly in detrusor in 20-40 injection points. Wherein solution of nitrofural is preliminarily cooled to temperature of 7-10 °C and selected dose of toxin in physiologic saline is introduced with temperature of 4-8 °C, using 0.5-1.0 ml of dissolved toxin for each injection.

EFFECT: method provides both prevention of hemorrhage in area of surgical manipulations and prevention of postoperative pain syndrome, requiring no additional economic and physical efforts.

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Description

The invention relates to medicine, in particular to urology, in particular to methods for treating detrusor hyperactivity.

The term detrusor hyperactivity is understood to mean an urodynamic phenomenon characterized by the presence of involuntary detrusor contractions during filling of the bladder with cystometry, accompanied by an increase in intradetussive pressure.

A known method of treating detrusor hyperactivity by prescribing anticholinergic therapy [1]. The disadvantage of this method is that with this type of treatment it is far from always possible to achieve a therapeutic effect. An unsatisfactory result may also occur in the case of the formation of resistance to anticholinergic therapy, the development of side effects or individual intolerance. Undesirable effects of anticholinergics are described, such as dry mouth, hyperemia and dry skin, decreased visual acuity due to accommodation spasms, abdominal pain, drowsiness, increased residual urine, decreased urination, and chronic constipation.

Closest to the claimed is a method of treating detrusor hyperactivity by local endoscopic injection of a botulinum toxin type A preparation into detrusor, at 20-40 injection points, at a dose of 100 to 300 IU [2].

The disadvantage of the method chosen as a prototype is the possible surgical complications: bleeding from injection sites, which complicate the intervention due to poor visibility, pain in the bladder, exacerbation of lower urinary tract infection.

Under storage conditions for botulinum toxin type A, temperatures from -5 ° C to -20 ° C for undiluted preparation and from + 4 ° C to + 8 ° C for diluted preparation are recommended. If these temperatures are not observed for 4 hours, an irreversible destabilization of the biological molecule of botulinum toxin type A occurs with a complete loss of its chemical and therapeutic properties.

The objective of the present invention is to increase the duration of the therapeutic effect of botulinum toxin type A while reducing bleeding in the area of surgical manipulation.

The technical result of the task is achieved by the fact that in the method of treating detrusor hyperactivity, including cystoscopy with filling the bladder with a solution of furacilin followed by injection of a solution of botulinum toxin type A directly into the detrusor at 20-40 injection points, the solution of furacilin is pre-cooled to a temperature of 7- 10 ° C and injected the selected dose of toxin in physiological saline at a temperature of 4-8 ° C, using 0.5-1.0 ml of diluted toxin for each injection.

The pathogenetic basis for reducing the severity of capillary bleeding is that at lower temperatures there is a spasm of peripheral vessels, which reduces or completely prevents bleeding at the injection site when the vessels are damaged by a needle, due to a significant decrease in the intensity of bleeding. This improves visibility during endoscopic manipulation and reduces the time of the procedure.

It is equally important that the cooling of the solution stops the rate of breakdown of the biological molecule of botulinum toxin type A in human tissues, increasing the percentage of unchanged botulinum toxin molecules entering the presynaptic membrane.

In addition, lowering the temperature of furatsilin contributes to the relief of subsequent pain in the postoperative period. Temporary intraoperative cooling of the bladder provides greater local selectivity, helps to reduce the unwanted diffusion of the drug into the surrounding tissue, significantly increases the chemical stability time of the botulinum toxin type A molecule in the tissue.

The method is as follows. The procedure is performed in an office for cystoscopic manipulations. The patient's position on the table, on his back, with legs apart. Intervention is performed under general anesthesia. After standard preparation (treatment of the external genitalia with an antiseptic), the bladder through the cystoscope is filled with a sterile solution of furatsilina 1: 5000, cooled to 7-10 ° C. After standard cystoscopy, injections of a solution of botulinum toxin type A in physiological saline at a temperature of 4-8 ° C are carried out directly in the detrusor, in an amount of 20 to 40 injection points, along the posterior, anterior and lateral walls of the bladder, with the exception of the trigonal region. For each injection, 0.5-1.0 ml of diluted botulinum toxin is used. At the end of the procedure, the bladder is empty.

Example 1. Patient K was admitted to SPbSPMU on November 14, 2013. Diagnosis: vesicle-dependent ureterohydronephrosis of 4 degrees from 2 sides, vesicoureteral reflux of 4 degrees from 2 sides. Chronic kidney disease, stage 4, chronic secondary pyelonephritis, chronic cystic-bullous cystitis. Narrowing of the intervertebral foramen at the level of L5-S1 with compression of the nerve roots. Loss of evacuation function of the bladder. Detrusor hyperactivity. The bladder capacity before treatment is 200 ml, there is significant detrusor hyperactivity.

12.12.2013, botulinum toxin detrusor hyperactivity was carried out by the claimed method. During the intervention, the introduction of botulinum toxin was carried out from 40 points, 1.0 ml each. In total, 300 units of toxin were introduced. There was no bleeding from the puncture zones of the bladder wall. In the early postoperative period, there was no development of pain, the girl was in constant catheterization of the bladder, no bleeding was detected from the bladder within 1-5 days.

Control urodynamic examination: with cystometry, there is a significant positive dynamics in the form of an active increase in adaptive ability and detrusor capacity, there is no detrusor hyperactivity, the bladder volume reached 400 ml. After 10 months, according to retrograde cystometry, a distinct positive dynamics remains, in the form of a complete restoration of adaptive ability and normalization of detrusor capacity, and the absence of hyperactivity. The patient feels healthy.

Example 2. Patient Ts was admitted to SPbSPMU on 03.06.2014. Diagnosis: dysfunction of the pelvic organs, urinary and fecal incontinence. The only left kidney, the state after nephrourerectomy on the right due to multicystosis, atresia of the rectum. Significant detrusor hyperactivity in the form of constant episodes of urinary incontinence, decreased bladder capacity.

06/23/2014 botulinum therapy of detrusor hyperactivity by the claimed method. At 300 detrusor points, 300 IU of botulinum toxin type A was added at a rate of 1.0 ml per point. The toxin was diluted with physiological saline 14-8 ° C. During the intervention, no bleeding from injection sites was noted. According to cystometry, 7 days after treatment, there was a complete elimination of detrusor hyperactivity. In the early postoperative period, the development of pain and delayed hematuria did not occur.

The inventive method is a simple, accurate, fast and budgetary method of enhancing the effects of botulinum toxin type A by increasing the decay time of its molecule in human tissues. Its use helps to prevent bleeding in the area of surgical manipulation due to spasm of the capillary bed, is a method for the prevention of postoperative pain. The implementation of the proposed method does not require additional economic and physical costs.

Information sources

1. Kazan, I.V. The role of M-anticholinergics in the rehabilitation of children with urinary disorders in hyperactive bladder / I.V. Kazan, E.L. Vishnevsky, P.O. Ignatiev, N.B. Gusev // Questions of modern pediatrics. - 2006. - Volume 5, No. 2. - S. 65-68.

2. Apolikhin O.I. et al. Treatment of neurogenic detrusor hyperactivity and detrusor-sphincter dysinergy with Lantox // Experimental and Clinical Medicine. 2010, No. 1.

Claims (1)

A method of treating detrusor hyperactivity, including cystoscopy with filling the bladder with a solution of furatsilin followed by injection of a solution of botulinum toxin type A directly into the detrusor at 20-40 injection points, characterized in that the furatsilin solution is pre-cooled to a temperature of 7-10 ° C and injected the selected dose of toxin in physiological saline at a temperature of 4-8 ° C, using 0.5-1.0 ml of diluted toxin for each injection.