RU2713816C1 - Method of treating children operated on for hydronephrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to paediatrics, paediatric urology, and can be used in treating children operated on for hydronephrosis. That is ensured by exposing the renal projection region to a high-intensity pulsed magnetic field from the AMT-2-AGS apparatus with amplitude of 200–700 mTl, pulse duration of 100 milliseconds, contact, stably, duration of exposure for 9 minutes, and course of 8–10 daily procedures.

EFFECT: method provides effective treatment of children with this pathology due to action in a certain mode on deep tissues and organs without irritant action under electrodes, which also improves urodynamics.

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Description

The present invention relates to medicine, in particular pediatrics, and can be used in children's medical organizations (hospital, medical rehabilitation center, clinic, sanatorium) for the treatment of children suffering from hydronephrosis.

The problem of medical rehabilitation of children with hydronephrosis is due to: a high frequency of occurrence (4%); the possibility of developing chronic renal failure (29%); early disability (25%) [1].

Hydronephrosis occupy a leading place among all congenital diseases (7%) of childhood. Surgery is one of the main methods of treating hydronephrosis, however, surgery is only one of the stages of treatment for this group of patients.

In the postoperative period, most patients still have a violation of urodynamics and renal blood flow due to hypoxia, hemodynamic disorders that developed in the kidneys against the background of obstruction of the pyelourethral segment with hydronephrosis. Often, hydronephrotic transformation of the kidneys is accompanied by the development of chronic kidney disease, up to nephrosclerosis and chronic renal failure.

Thus, the success of surgical interventions largely depends on the implementation of rehabilitation treatment at various stages of medical rehabilitation. After operations on the ureter, the use of medical technology is important. rehabilitation aimed at preventing urodynamic disorders of the upper and lower urinary tract, stimulating reparative processes, improving renal blood flow.

In the treatment of hydronephrosis, the most commonly used medications are antibacterial drugs (amoxiclaf, cephalosporins 2-3 generations, uroseptics (furagin, furamag) for the relief of infectious complications and the so-called nephroprotectors - angiotensin converting enzyme inhibitors, as well as energotropic therapy kesrom, elancar , Limontar) (Obstructive uropathies in childhood // Edited by S.L. Kovarsky, LB Menovschikova and others. S - M .: GEOTAR-Media, 2011.240 s).

Traditionally, against the background of medical correction or independently apply physiotherapy methods that allow you to influence the various pathogenetic links of the disease, primarily on the correction of urodynamics, as well as renal blood flow and the functional state of the kidneys.

Among the most effective methods of physiotherapy should be noted drug electrophoresis, laser therapy, pulsed currents.

However, drug electrophoresis of uroseptics, calcium, iodine has a local irritant effect under the electrodes, individual intolerance to direct current is often noted, allergic reactions to drugs may occur, in addition, the use of this method does not have a significant effect on urodynamics.

Such treatment methods as ultrasound and laser therapy also have several disadvantages: firstly, they are used in children after the first year of life, and often earlier, already in the first year of life, treatment of hydronephrosis that has been started contributes to a more effective correction of this problem and avoids the development of chronic kidney disease; secondly, these physiotherapy methods have a beneficial effect on metabolic and trophic processes in the renal parenchyma and renal blood flow, with little effect on the contractile function of the pelvis and ureter, so necessary to restore urodynamics.

Closest to the technical nature of the proposed method is a method of treating hydronephrosis using sinusoidal modulated currents on the area of the projection of the kidneys. A transverse technique is used, 1 mode of operation, 3 type of work, modulation frequency -50 Hz, modulation depth 75%, 6-8-10 minutes depending on age, daily, for a course of 10-12 procedures (Physical and rehabilitation medicine: national manual / Edited by G.N. Ponomarenko. M. GEOTAR-Media, 2017).

The disadvantages of this method are: the involvement in the sphere of influence of a larger volume of tissue located between the electrodes, which limits the possibility of targeted action on the internal organs; modulations during SMT therapy occur in the apparatus itself and when brought to the body are actively absorbed along the entire path of their distribution; the occurrence of an irritating effect under the electrodes and the development of a negative reaction of the child, especially when working on a constant modulation mode; less pronounced and prolonged stimulating effect on the muscular system in sinusoidal modulated currents, compared with high-intensity pulsed magnetotherapy.

The technical result of the proposed method is the ability to influence deeply located internal organs, obtain a pronounced myostimulating effect, not cause irritation under the electrodes, restore urodynamics, improve renal blood flow, and reduce the activity of inflammation in the organs of the urinary system.

The indicated technical result is achieved by exposure to a high-intensity pulsed magnetic field from the AMT-2-AGS apparatus with an amplitude of 200-700 mT, pulse duration of 100 milliseconds on the projection area of the kidneys, contact, stable, exposure duration of 9 minutes, for a course of 8-10 daily procedures .

This method uses a high-intensity pulsed magnetic field from the AMT-2-AGS apparatus, under the influence of which electric currents are induced in the tissues of the body, the density of which is high enough, which allows one to obtain pronounced biological effects, including the magnetostimulation phenomenon, which the turn helps to restore the evacuation function of the kidneys, improve metabolic and trophic processes in the renal parenchyma and renal blood flow.

In addition, the induction of electric current occurs evenly at any depth and in any tissues, which allows you to affect deeply located organs.

In this method, the amplitude of magnetic induction is 200-300 mT and the interval between pulses in the package is 100 ms, which can provide an anti-inflammatory effect, increased blood flow and metabolic trophic processes and the amplitude of magnetic induction is 500-700 mT and the interval between pulses in the package is 100 ms, which allows achieve smooth muscle stimulation, increased blood flow and metabolic trophic processes.

The use of a 9 minute exposure is sufficient for the development of a persistent clinical and functional effect with a long aftereffect.

DESCRIPTION OF THE METHOD OF TREATMENT

The patient is laid on a wooden couch. Previously, the apparatus is turned on in order to prepare it for the procedure. On the patient’s body, 1 inductor is placed paravertebrally onto the segmented reflexogenic zone L ₁ -L ₃ and 2 electrodes are placed on the projected area of the operated kidney from the side of the anterior abdominal wall of the abdomen; the inductors are fixed using a sand bag or rubber bandages. The impact is carried out by a pulsed magnetic field with an amplitude of 200-700 mT, a duration of 100 milliseconds and a duration of exposure of 9 minutes, on a course of 8-10 daily procedures.

EXAMPLES OF IMPLEMENTATION OF THE METHOD

EXAMPLE 1. Averin Timofei, 3 years old, was admitted to the Department of Urology, Children's Clinical Hospital №13 named after N.F. Filatova with a diagnosis of Hydronephrosis on the right, condition after laparoscopic plasty of the pyelourethral segment on the right, stenting.

From the anamnesis it is known that a child under 3 years old was observed by a pediatrician with Dz. Is healthy. A general urine test, a general blood test were examined regularly, and no pathology was detected. An ultrasound scan of the kidneys and bladder was not performed. Early development by age. At 3 years old, with complaints of abdominal pain, decreased urine output, they were hospitalized in the Department of Urology of Children's Clinical Hospital No. 13 named after N.F. Filatova. Early development by age. Upon admission to the clinic, the condition of a child of moderate severity. On examination: normosthenic physique, clean skin, respiratory system and cardiovascular system - without features. The abdomen is soft, painless in all departments. The symptom of striking is positive on the right side. The chair is regular. Urination is rare, painless, sufficient diuresis.

The following examinations were carried out in the department:

Clinical blood test: L 8.4 × 10 ⁹ / L, Er 4.2 × 10 ¹² / L, HB 121 g / L, E 2%, P 0%, C 48%, L 42%, M 8%, ESR 10 mm / h, Tr 198 × 10 ⁹ / L.

Blood biochemical analysis: AST-28, ALT-21, cholesterol 5.3 mmol / L, Ca 2.14 mmol / L, K 4.9 mmol / L, Na - 143 mmol / L, urea 3.5 mmol / L , creatinine 34 μmol / L, sugar 4.6 mmol / L.

Urinalysis: reaction - acid, pH - 5, beats. weight - 1021, protein - 0, white blood cells - 5-6 in n / a, red blood cells - 0-1 in n / a, epithelium - single, bacteria - not.

Sowing urine on the flora - there is no growth of flora.

Examination:

Ultrasound examination of the kidneys and bladder with dopplerometry of the renal blood flow:

Kidneys - left kidney - topography not changed, 80 × 26 mm, parenchyma thickness 9 mm, cortico-medullary differentiation not changed, pelvis 5 mm mixed type. CDC: blood flow is not changed, can be traced to the capsule, right kidney - topography is not changed, 106 × 60 mm, parenchyma thickness is 6 mm, somewhat increased echogenicity, cortico-medullary differentiation is not changed, pelvis 49 mm, all groups of calyx are expanded to 23 mm. CDK: blood flow is not changed, can be traced to the capsule. CDK: the blood flow is depleted, can be traced to the capsule, Ureters: not expanded throughout. Bladder: volume - 48 ml, thin walls, suspension in the lumen. Conclusion: echographic signs of hydronephrosis on the right.

An emergency procedure was performed cystoscopy - the mucous membrane of the bladder is pale pink. Without inflammation, in the lumen - fine suspension, the mouths are usually located, closed. A stent Uroteck No. 4 Ch15 was placed in the pelvis of the right kidney.

Received infusion therapy, orzid, amikacin, driptan. Discharged under the supervision of a urologist. A month later, a planned operation was performed - laparoscopic plastic surgery of the pyelourethral segment on the right. Ureteral stent replacement. The postoperative period was uneventful, without features. Discharged on the 7th day.

Re-hospitalization after 4 months. to remove the stent.

After stent removal, proteinuria up to 0.2 g / l was noted; leukocyturia up to 30 in n.p., expansion of the collector system of the kidneys (by ultrasound, increase of the pelvis up to 29 mm, upper cup up to 9 mm).

On the 2nd day after the stent is removed, the child is assigned a high-intensity pulsed magnetotherapy. The patient was laid on a wooden couch. On the patient’s body, 1 inductor was placed paravertebrally on the segmented reflexogenic zone L ₁ -L ₃ and 2 electrode on the projection area of the pelvis of the right kidney from the side of the anterior abdominal wall of the stomach, the inductors were fixed using a sand bag. The exposure was carried out by a pulsed magnetic field with a duration of 100 milliseconds and an amplitude of 200 mT, exposure duration of 9 minutes, daily, 3 procedures, then an amplitude of 500 mT, exposure duration of 9 minutes, 7 procedures daily.

He transferred the first procedure well. In the course of treatment, by the middle of the course (in the 4-5th procedure), an improvement in health was noted. When examined by the middle of the course of treatment, a decrease in the activity of inflammation in the organs of the urinary system was noted, as evidenced by a decrease in proteinuria and leukocyturia.

Urinalysis: reaction - acid, beats. weight - 1016, protein - negative, white blood cells - 1-2 in n. sp., red blood cells - 0-1 in n. sp.

Sowing urine on the flora: no growth.

As a result of treatment with the proposed method, along with the improvement of the clinical picture of the underlying disease and clinical and laboratory parameters, the beneficial effect of high-intensity pulsed magnetotherapy on the state of urodynamics and renal blood flow was established according to the data of renal ultrasound and renal blood flow dopplerometry (reduction of the size of the pelvis and restoration of renal blood flow).

Ultrasound examination of the kidneys and bladder with dopplerometry of the renal blood flow after treatment:

Kidneys — left kidney — topography not changed, 82 × 28 mm, parenchyma thickness 10 mm, cortico-medullary differentiation unchanged, pelvis 4 mm of mixed type. CDC: blood flow is not changed, can be traced to the capsule, right kidney - topography is not changed, 85 × 35 mm, parenchyma thickness is 9 mm, cortico-medullary differentiation is not changed, pelvis 18 mm, upper cups 7 mm. CDK: blood flow is not changed, can be traced to the capsule. Ureters: not dilated all over. Bladder: volume - 62 ml, the walls are thin. Conclusion: echographic signs of hydronephrosis on the right, the state after surgery.

EXAMPLE No. 2

Lapina Alexandra, 10 years old, was in Children's Clinical Hospital No. 13 with the Diagnosis: Hydronephrosis on the right, the condition after laparoscopic plasty of the pyelourethral segment on the right, stenting. Pieloectasia on the left. From the anamnesis it is known that the child was observed from birth by a pediatrician with Dz. Is healthy. At 9 years old she was hospitalized with Dz. Food toxicoinfection in the Amur Regional Children's Clinical Hospital, examination revealed a hydronephrotic transformation of the right kidney according to renal ultrasound. Consulted in the CDC DGKB №13 named after N.F. Filatova as a pediatric urologist, is sent for planned hospitalization in the Department of Urology of Children's Clinical Hospital No. 13 named after N.F. Filatova

Upon admission to the clinic, the condition of a child of moderate severity. On examination: asthenic physique, clean skin, respiratory system and cardiovascular system - without features. The abdomen is soft, painless in all departments. The symptom of striking is negative on both sides. The chair is regular. Urination is rare, painless, sufficient diuresis.

The following examinations were carried out in the department:

Clinical blood test: L 6.4 × 10 ⁹ / L, Er 5.1 × 10 ¹² / L, HB 137 g / L, 3%, P 0%, C 56%, L 36%, M 5%, ESR 8 mm / h, Tr 267 × 10 ⁹ / L.

Blood biochemical analysis: AST-21, ALT - 18, cholesterol 3.3 mmol / L, Ca 2.34 mmol / L, K 3.7 mmol / L, Na - 152 mmol / L, urea 4.7 mmol / L , creatinine 58 μmol / L, sugar 4.8 mmol / L.

Urinalysis: reaction - acid, pH - 5, beats. weight - 1021, protein - 0, white blood cells.

Ultrasound examination of the kidneys and bladder with dopplerometry of the renal blood flow:

Kidneys — the left kidney — the topography is not changed, the contours are even, clear, dimensions are 101 × 40 mm, the thickness of the parenchyma is 12 m, the cortico-medullary differentiation is not changed, the pelvis is 18 mm. CDK: blood flow is not changed, it can be clearly traced to the capsule, right kidney - topography is not changed, the contours are even, clear, dimensions 110 × 45 mm, parenchyma thickness 8 mm, corticotomedular differentiation preserved, pelvis 46 mm, all groups of calyx extended to 12-16 mm. CDK: the blood flow is depleted, not in all departments it is traceable to the capsule, Ureters: not expanded. Bladder: volume - 72 ml, wall thickness is not changed, the lumen is echo-negative. Conclusion: echo signs of pyeloectasia on the left, hydronephrosis on the right. Cystography: The contours of the bladder are clear, even. PMR is not determined. According to a radioisotope study of the kidneys, mild focal changes in the left kidney against diffuse changes in the parenchyma, pronounced focal changes in the right kidney. The secretory function of the left kidney is normal, the secretory function of the right kidney is reduced. Biochemical analysis of urine: diuresis 1620 ml, protein 0.278 g / day, phosphorus 49.3 mg / kg / day, calcium 1.58 mg / kg / day, uric acid 2342 mg / day, creatinine 681 mg / day, oxalates 41 mg / day, titer , acids 26 mM / day, ammonia 82.6 mM / day, sodium 49.2 meq / day, potassium 61.82 meq / day, chlorides 57.62 meq / day, urea 112.412 mM / l.

Blood type A (2), Rh positive.

After examination, the child underwent surgery: Cystoscopy, intubation of the right ureter. Laparoscopic pyeloplasty on the right. The postoperative period was uneventful. After a month, the child is re-hospitalized to remove the stent. At admission: a state of moderate severity.

Urinalysis: reaction - alkaline, pH - 7, beats. weight - 1012, protein - 0.267 g / l; white blood cells - 20-30 in n.a.

Ultrasound examination of the kidneys and bladder with dopplerometry of the renal blood flow:

Kidneys — the left kidney — the topography is not changed, the contours are even, clear, dimensions are 92 × 36 mm, the thickness of the parenchyma is 10 m, the cortico-medullary differentiation is not changed, the pelvis is 27 mm. CDK: blood flow is not changed, it can be clearly traced to the capsule, right kidney - topography is not changed, the contours are even, clear, dimensions 99 × 32 mm, parenchyma thickness 6-8 mm, corticotomedullary differentiation preserved, pelvis 17 mm (on the stent), all cup groups expanded to 7-10 mm. CDK: blood flow is weakened, can be traced to the capsule. Ureters: not dilated. Bladder: volume -20 ml, echo-negative lumen.

Cystoscopy was performed with stent removal. On the 2nd day, after removal of the stent, a high-intensity pulsed magnetotherapy was prescribed. The patient was laid on a wooden couch. On the patient’s body, 1 inductor was placed paravertebrally on the segmented reflexogenic zone S ₁ -S ₃ and 2 electrode on the projection area of the bladder, the inductors were fixed using a sand bag. The exposure was carried out by a pulsed magnetic field with a duration of 100 milliseconds and an amplitude of 300 mT, an exposure duration of 9 min, daily, 3 procedures, then an amplitude of 700 mT, an exposure duration of 9 min, 7 procedures daily.

I transferred the first procedure well. In the course of treatment, by the middle of the course (at 4-5 procedures), the patient's condition improved, the girl became more active. When examining after a course of treatment:

Urinalysis: reaction - acid, beats. weight - 1014, protein - 0.13, white blood cells - 1-2 in s / sp.

Ultrasound examination of the kidneys and bladder with dopplerometry of the renal blood flow:

The kidneys - the left kidney - the topography is not changed, the contours are even, clear, dimensions are 99 × 38 mm, the thickness of the parenchyma is 10 m, the cortico-medullary differentiation is not changed, the pelvis is 8 mm. CDC: blood flow is not changed, it can be clearly traced to the capsule, right kidney - topography is not changed, the contours are even, clear, dimensions are 101 × 38 mm, parenchyma is 8 mm thick, cortico-medullary differentiation is preserved, pelvis 10 mm, all groups of calyx are expanded to 8 -9 mm. CDK: blood flow is traced to the capsule, Ureters: not dilated. Bladder: volume - 20 ml, echo-negative lumen.

The impact of high-intensity magnetotherapy was characterized by an improvement in the evacuation function of the kidneys and renal blood flow according to renal ultrasound and Doppler measurements of the renal vessels. A decrease in proteinuria and leukocyturia after a course of treatment indicated a decrease in the activity of inflammation in the organs of the urinary system.

The proposed method of treatment was applied in 40 children with hydronephrosis, after surgical treatment and stenting. All children tolerated treatment with the proposed method, no adverse reactions were noted. By the end of the course of treatment, all patients improved their well-being, there was a reduction in the size of the operated pelvis, which indicated the restoration of urodynamics. All children showed an improvement in renal blood flow, a decrease in the activity of inflammation in the organs of the urinary system.

The anti-inflammatory effect was manifested in a significant decrease in leukocyturia (in total an. Urine from 34.4. ± 0.32 units to 2.38 units ± 0.11 units, p <0.05) and proteinuria (in total. urine count from 286.3. ± 7.4 mg / l to 102.8 g / l ± 6.3 mg / l, p <0.05) in 90% of children.

A favorable effect of high-intensity pulsed magnetotherapy on the state of urodynamics was established, as evidenced by the reduction in the size of the pelvis and calyx according to the ultrasound of the kidneys.

Exposure to a high-intensity magnetic field was characterized by an improvement in renal blood flow according to dopplerometry of the renal vessels.

As a result of treatment, improvement and significant improvement were observed in 85.0% of patients.

Follow-up observation revealed a favorable effect of a high-intensity pulsed magnetic field for 2 months, which was characterized by the absence of infectious complications, preservation of the size of the pelvis, operated kidney and the intensity of renal blood flow to the cortical regions.

As a result of treatment with this method, it was revealed that: children operated on for hydronephrosis can be included in medical rehabilitation programs with high-intensity pulsed magnetotherapy to restore urodynamics, improve renal blood flow, and reduce and inflammation in the organs of the urinary system.

Claims (1)

A method of treating children operated on for hydronephrosis by exposure to a physical factor, characterized in that they act as a physical factor with a high-intensity pulsed magnetic field from an AMT-2-AGS apparatus with an amplitude of 200-700 mT, pulse duration of 100 milliseconds on the area of the projection of the kidneys, contact , stable, exposure duration of 9 minutes, on a course of 8-10 daily procedures.