RU2626594C1 - Method for chronic cystitis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: intravesical installations are performed with preliminary bladder mucosa exposure to a laser. The laser action is carried out by emission of a high-energy YAG-Nd (yttrium-alumogranate with neodymium) laser, conducting point coagulation of the mucosa for 2 seconds per point, at 8-12 points.

EFFECT: increased effectiveness of chronic cystitis treatment due to coagulation of the mucosa coated with biofilms, to improve antibacterial substance penetration to the infectious agent.

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Description

The invention relates to medicine, namely to urology.

According to the latest data from the National Hospital Ambulatory Medical Care Survey in the United States, more than 7 million cases of urinary tract infection (UTI) are detected annually in outpatient practice, of which more than 2 million are caused by cystitis [1]. Within 6-12 months after the first episode of UTI, 25-40% of them develop a recurring uncomplicated urinary tract infection [2], which in Russia is interpreted as chronic cystitis [3-4]. Among all diseases of the urinary tract, infectious and inflammatory diseases take first place and have a high proportion (60-70%). The prevalence of urinary tract infections in Russia is about 1000 cases per 100,000 population per year and tends to increase and chronicity of the process. Among them, cystitis in various age groups is diagnosed 3-5 times more often in women than in men [4].

The low effectiveness of antibiotic therapy is due to the formation of biofilms, which prevent the penetration of antibiotics to the infectious agent. All known methods are distinguished by the instability of the achieved effect: in 50% of cases, the disease recurs. To a large extent, this is due to an increase in the resistance of uropathogenic microflora; in a biofilm, the immunity of microorganisms to antibacterial drugs approaches 100%. So far, no one has attempted to destroy the formed biofilm.

There is a method of increasing the efficiency of treatment of patients with chronic cystitis using the additional purpose of the immunomodulator Genferon [5]. However, the use of geneferon does not affect the formation of biofilms.

Also known is a method of treating chronic cystitis in the acute stage of furamag and adaptol. This method led to a more rapid relief of anxiety-depressive disorders in patients, but also did not affect the formation of biofilms [6].

Also known is a method of treating chronic cystitis with standard therapy in combination with phototherapy using the Svetozar apparatus. According to the results of the study, the use of phototherapy with the Svetozar apparatus in combination with standard treatment led to a faster relief of the clinical signs of the disease and a more pronounced improvement in the psycho-emotional state of patients, which made it possible to increase their quality of life. However, the known method did not affect the biofilm and, therefore, did not prevent relapse [7].

There is a method of treating patients with chronic recurrent bacterial cystitis in the acute stage with combination therapy using Prolit super septo, which made it possible to more effectively stop the inflammatory process and clinical symptoms of diseases, adjust the psychoemotional status of patients, and restore normal chronorms regardless of the localization of the inflammatory process [8].

The proposed method for the treatment of chronic cystitis with intravesical installations, characterized in that they preliminarily perform a point impact on the mucous membrane of the bladder by radiation of a high-energy YAG-Nd (sodium-aluminum garnet with neodymium) laser for 2 seconds per point, 8-12 points in total, allows short-term pulses of a high-energy laser coagulate the mucosa covered with a biofilm, and create conditions for the penetration of an antibacterial substance to an infectious agent.

The method is carried out under operating conditions under general or epidural anesthesia. The patient is placed on the operating table with legs raised and bent at the knees; the legs are fixed. The crotch is treated twice with an aqueous solution of chlorhexidine; the urethra is installed with 5 ml of cathegel. A fibrocystoscope is inserted into the bladder. Through the drainage system, the bladder is filled with a sterile 0.9% sodium chloride solution.

Perform examination cystoscopy, determine the area of the intended impact. A light guide is brought through the cystoscope, the effect is carried out at 8-12 points. At the end of the procedure, saline is released, the cystoscope is removed. In the postoperative period, a course of installations with dioxidine 10 ml, 10 procedures per course is carried out.

A method for the treatment of chronic cystitis was tested in 6 patients at the urogenital clinic of the FSBI NNIIT of the Ministry of Health of the Russian Federation. In all, the course of dioxidine installations after the destruction of the biofilm led to a persistent remission of the disease.

The treatment results are presented in the table.

All patients restored urination, normalized urine tests, eradication of pathogenic microflora began, although one patient, with a long history, had moderate pain during filling of the bladder.

Within a year after the implementation of the proposed method, the disease did not recur.

Example. Patient D. 54 years. Suffers from chronic cystitis for 14 years, polyresistant microflora (mainly E coli, Klebsiellaspp, Enterococcusfaecalis) is constantly sown in the urine in a high titer of 10 × 6-10 × 7 CFU / ml. Numerous courses of various antibacterial drugs of all groups (nitrofurans, cephalosporins, fluoroquinolones) have never completed with a complete normalization of urinalysis. Chronic cystitis recurred 3-4 times a year. The patient was treated according to the claimed method with coagulation at 12 points. After a month, the patient complained of minor pain when filling the bladder; urine tests were normal, uropathogens were not detected, urination became free and painless.

During the follow-up examination after a year, the patient reported that for the first time in 14 years during the year she did not experience a single relapse of cystitis. Urine tests remained normal, there was no growth of microflora.

A method of treating chronic cystitis with intravesical installations, characterized in that they preliminarily conduct a point impact on the mucous membrane of the bladder by radiation of a high-energy YAG-Nd (yttrium aluminum garnet with neodymium) laser for 2 seconds per point, 8-12 points in total, highly effective, available, well tolerated by patients.

Literature

1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity and economic costs. Am J Med 2002; 113 (Suppl 1 A): 5S-13.

2. Martin D, Fougnot S, Grobost F, et al. Prevalence of extended-spectrum beta-lactamase producing Escherichia coli in community-onset urinary tract infections in France in 2013. J Infect. 2016 Feb; 72 (2): 201-6. doi: 10.1016 / j.jinf.2015.11.009. Epub 2015 Dec 15.

3. Kulchavenya E.V. Chronic cystitis in women: how to prevent relapse? / E.V. Kulchavenya, E.V. Brizhatyuk, A.A. Breusov // XII Congress of the Russian Society of Urology: Materials. - Moscow, 2012 .-- p. 141.

4. Kulchavenya E.V. 2012 .-- p. 141. E.V. Bladder diseases (monograph) / E.V. Kulchavenya, A.I. Neymark., Yu.S. Kondratyev // Germany: Palmarium Academium Publishing, 2013 .-- 140 p.

5. Kuzmenko V.V. Genferon in the treatment of chronic bacterial cystitis / B.V. Kuzmenko, O.V. Zolotukhin, A.V. Kuzmenko et al. // Scientific Medical Bulletin of the Central Black Earth Region. 2008. No. 34. S. 93-94.

6. Kurnosova N.V. Actual aspects of pharmacotherapy of chronic cystitis in the acute stage in women / N.V. Kurnosova, A.V. Kuzmenko

B. V. Kuzmenko // Saratov Journal of Medical Scientific Research. 2010. T. 6. №3. C. 705-708.

7. Gyaurgiev T.A. Treatment of patients with chronic recurrent bacterial cystitis in the acute stage in combination with phototherapy "SVETOZAR". / T.A. Gyaurgiev, A.V. Kuzmenko, V.M. Vakhtel, P.A. Lukyanovich // System analysis and management in biomedical systems. 2014.Vol. 13. No. 4. S. 821-824.

8. Kuzmenko A.V. Chronobiological aspects of the use of PROLITA SUPER SEPTO in patients with infectious and inflammatory diseases of the urinary system. / A.V. Kuzmenko, V.V. Kuzmenko, T.A. Gyaurgiev, D.E. Stroeva. //Urology. 2015. No4. S. 19-23.

Claims (1)

A method for the treatment of chronic cystitis, including intravesical installations with preliminary laser irradiation of the mucous membrane of the bladder, characterized in that the laser irradiation is carried out by radiation of a high-energy YAG-Nd (sodium-aluminum garnet with neodymium) laser, conducting point-wise coagulation of the mucosa for 2 seconds at a point of 8- 12 points.