RU2731802C1 - Electric ureter stimulation technique - Google Patents

Abstract

FIELD: medicine; biophysics.

SUBSTANCE: invention relates to medicine and biophysics, can be used in pediatrics, nephrology, urology. Electric oscillations are excited in the patient's body by means of electrodes, one of which is located in the area of the pubic bone, and the other is paravertebral along the external edge of the spinal straightening muscle in the area between the XII rib and the sacral segment. Feed electric oscillation occurs sequentially for every paravertebrally electrodes disposed in the direction of sacral pulse signal generated in the burst. Further, the signal is supplied with amplitude of 12 V, pulse repetition frequency in the pack is selected to be 5 kHz, the repetition frequency of the packs is selected to be 3–30 Hz, wherein the pulse packets are continuously supplied. Excitation carried out for 3–5 minutes 1 time per day for 5–20 days.

EFFECT: what is presented is a method for ureter stimulation.

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Description

The invention relates to the field of medicine and biophysics, can be used in pediatrics, nephrology, urology.

There is a known method for restoring the urodynamics of the upper urinary tract (see RF patent No. 2263519 according to IPC A61N 1/32, publ. 10.11.2005), including the stimulation of the ureter due to sequential impulse transmission to isolated from each other contact surfaces of the electrodes. To do this, during the operation, a multi-contact electrode-catheter is placed and fixed along the ureter. Its free end is brought out together with a drainage tube. Electrical stimulation begins from the first day after the operation, is carried out twice a day for 5-10 minutes with pauses between sessions. They act with impulses with a duration of 5-10 ms with a repetition period of 20-30 ms, grouped into a batch of 0.3-0.6 duration and a repetition rate of 0.3-0.4 Hz. Pulse voltage 2-4 V, pulse current 2-4 mA. The delay time of the impulse delivery between adjacent pairs of contact surfaces is 1-3 sec. Pauses between sessions are 1.5-2 hours. The sessions are carried out within 3-8 days.

However, this method is invasive, and therefore carries the risk of ascending infection and damage to the tissues of the ureter. Also, this method worsens the patient's quality of life, namely, leads to disruption of normal urination and forces the use of a drainage device.

There is a known method of neuromuscular electrical stimulation (see RF patent No. 2281790 according to class IPC A61N 1/36, publ. 20.08.2006), which consists in exposing a part of the human body immersed in water with an electric current through electrodes connected to a current source, separated by a dielectric layer and immersed in water in the immediate vicinity of the stimulated area of the body without direct contact with it. When implementing the method, the lines of electric current flowing between the electrodes are closed not only through the water in which the human body is immersed, but partially also through his body. As a result, an electric current passes through a part of the human body immersed in water, which causes a stimulating effect. The level of exposure is controlled by changing the distance between the body and the electrodes and / or their orientation relative to the body.

The disadvantage of this method is the low selectivity in the area of exposure, which ultimately sharply reduces the effectiveness of therapy for deep-lying soft tissues, in particular the ureter. The method does not have a special task of treating the ureter. To implement the method requires immersion of a part of the body in water.

The closest solution to the declared is a non-invasive method of facilitating the passage of urine in the ureter (see RF patent No. 2564753 according to class IPC A61N 1/32, publ. 10.10.2015). The method includes exposure to an electric current through the electrodes. One electrode is placed in the region of the pubic bone, the rest - paravertebrally along the outer edge of the muscle that straightens the spine. A signal is supplied with a frequency in the range of 5-32 kHz, an amplitude of no more than 3 V, a current of no more than 20 mA, formed into a pulse with a duration of 0.1-0.2 msec. The pulses are formed in packs with a duration of 0.5-1 sec, the time between pulses in a pack is 0.01-0.8 sec. Affect successively on each paravertebral electrodes in the direction of the sacral region with a delay of 5 seconds. After 5 seconds, repeat the sequential supply of packets of impulses to the paravertebral electrodes from the XII rib to the sacral region. The impact is carried out for 5-10 minutes, once a day for 5-20 days. The method increases the effectiveness of treatment by restoring the tone of the upper urinary tract.

The disadvantage of this method is the possibility of reflux and urine back into the kidney, which ultimately leads to an aggravation of the inflammatory process.

The technical problem is to improve the non-invasive method of electrical stimulation of the ureter, which makes it possible to eliminate the risk of an inflammatory process.

The technical result is to exclude reflux and urine back into the kidney while improving the therapeutic effect.

The technical result is achieved by the fact that in the method of electrostimulation of the ureter, which consists in the excitation of electrical oscillations in the patient's body with the help of electrodes, one of which is located in the region of the pubic bone, and the rest in an amount of at least six paravertebrally along the outer edge of the muscle that straightens the spine, in the area between the XII rib and the sacral region, and supplying successively to each paravertebral electrodes in the direction to the sacral region of the pulse signal formed in a pack, according to the invention, a signal with an amplitude of 10-12 V is supplied, the pulse repetition rate in the pack is chosen 5 kHz, the repetition rate of the packs choose 3-30 Hz, while the bursts of pulses are fed continuously. Excitation is carried out for 3-5 minutes, once a day for 5-20 days.

A signal with an amplitude of 10-12 V is supplied from a direct current source, which makes it possible to exclude, in comparison with the prototype, galvanic isolation, as well as to completely exclude the flow of a current dangerous for the patient.

The invention is illustrated by drawings, where:

- in Fig. 1 is a block diagram of a device that implements the inventive method, and also shows the location of paired electrodes and one common;

- in Fig. 2 and 3 - shows the determination of the rate of passage of urine in the ureter by ultrasound in patient N. 11 years old, with chronic pyelonephritis without electrical stimulation (Fig. 2) and with electrical stimulation at a frequency of 3 Hz (Fig. 3);

- in Fig. 4 is a diagram of the ureter.

Positions in the drawings indicate:

1 - battery;

2 - pulse generator based on the Arduino Uno microcontroller;

3 - block for forming alternating current pulses;

4 - common electrode;

5 - paravertebral electrodes;

The method is carried out as follows.

To implement electromyostimulation, the patient is placed on a couch and electrodes are placed on the back of at least three pairs of electrodes. The electrodes are installed paravertebrally from top to bottom (Fig. 1). Each electrode is lubricated with an electrically conductive gel or saline solution. To generate pulses, use a device consisting of a pulse generator 2 based on the Arduino Uno microcontroller (Fig. 1), which receives power from a battery 1, an alternating current pulse shaping unit 3. At the output of block 3, the generated signal was fed to the electrodes 5. The operation of the device consisted of the formation of a traveling burst of pulses on the electrodes 5.

On the upper pair of electrodes 5 (Fig. 1), relative to one common electrode 4, the first burst of alternating current pulses is supplied through the first channel, then through the second channel the signal is fed to the middle pair of electrodes (Fig. 1), then through the third channel to the lower pair (Fig. . 1), then the cycle returns to the top pair of electrodes. Common electrode 4 is an electrode located in the bladder region.

By varying the repetition rate of pulse packs, the quantitative characteristics of ureteral output into the bladder are simultaneously monitored using ultrasound. The total exposure time usually does not exceed 5 min with a channel switching frequency of 3-30 Hz, a pulse frequency in a packet of 5 kHz. The pulse amplitude is 10-12 V, the pulse duration is 0.1 msec.

The choice of the boundaries of the amplitude value is due to the fact that in this interval the patient does not yet have a feeling of discomfort while maintaining the therapeutic effect. If the amplitude of the pulses is reduced, in particular to 3 V, then the response of the ureter becomes smaller and the therapeutic effect is minimized.

The high repetition rate of stimulation pulses in the pack, in contrast to the prototype, namely 5 kHz, makes it possible to increase the duration of the ureteral ejection in most cases (80%) and to achieve normal values.

Continuous repetition of packets of impulses provides a "traveling wave" effect and imposition of the frequency of the stimulation signal on the ureter, which ultimately leads to the normalization of the parameters of rhythmogenesis and functional activity of the ureters.

Ultrasound monitoring of the dynamic change in ureteral output was carried out on an expert-class apparatus using a standard contextual transducer with a frequency in the range of 2-5 MHz.

The proposed stimulation mode is selected on the basis of a study of the literature, known stimulation techniques and clinical observations. When implementing the method, the functional activity of the ureters was assessed using ultrasound to determine ureteral emissions. In the mode of pulsed dopplerometry of the renal vessels (IDM), quantitative parameters were assessed: the number of peaks (waves), the number of ejections per unit time, the duration of one ejection (T), the maximum (Vmax) and minimum (Vmin) ejection velocities.

In accordance with the condition of continuity, as the pipe section narrows, the speed of the continuous flow inside it increases in proportion to this narrowing. As a result, as the pipe cross-section decreases, the resistance to the fluid flow increases, and its movement becomes more and more difficult.

Since all the liquid in the pipe is assumed to be inert and driven only by an external force, along the entire length of the pipe it experiences only resistance to movement and deceleration, which, due to the incompressibility of the fluid, is fully transferred to the pipe inlet. In this case, the narrowing of the pipe increases the resistance and therefore, to improve the throughput, other things being equal, it is necessary to increase the pipe diameter.

As shown in FIG. 4, we will locate at least three points of control and stimulation on the studied area. Then the time between the sections will be t1 and t2, respectively. Based on the anatomical data, the following boundary conditions are admissible:

L (total length) = 20cm = 0.2m

Vmin (minimum speed) = 2.3 cm / s = 0.023 m / s

Vmax (maximum speed) = 60cm / s = 0.6m / s

If we assume that section one has the same value with the second section and is equal to 7 cm, then we estimate the time of passage of the pulse wave through the control points:

t2 = t1 => min 0.07 / 0.0.23 = 3.04 seconds

max 0.07 / 0.6 = 0.12 seconds

Example 1.

Patient N., 14 years old, was in the clinic of the Faculty of Pediatrics of the Clinical Hospital named after S.R. Mirotvortseva SSMU with a diagnosis of secondary obstructive and dysmetabolic pyelonephritis, chronic course, period of remission, without impaired renal function. Congenital anomalies of the urinary system (VAMVS): intrarenal vessel on the right. From the anamnesis it is known that the girl has been registered with a nephrologist with this diagnosis since 2012. The clinic carried out an examination: in the general analysis of blood - without inflammatory changes. Blood biochemistry: no pathology. In the general analysis of urine: no inflammatory changes. An ultrasound of the kidneys was performed: moderate pyelectasis on the right was revealed. Excretory urography: the kidneys secrete contrast in a timely manner. On the right is moderate pyeloectasia, intrarenal vessel. On the left, the pelvis is normal. Vocational cystourethrography: no refluxes were detected.

In order to study the urodynamics of the upper urinary tract, the determination of ureteral emissions was carried out. When conducting ultrasound examination without electromyostimulation, a symmetric urine velocity in the ureter is observed in the range of 24.9-25 cm / s with a frequency of 0.42 Hz (40 times per minute). When determining the ureteral ejection, a decrease in the maximum and minimum emission velocities was also noted: Vmax on the right 24.5 cm / s, Vmax on the left 25.6 cm / s, (norm 51.0 ± 0.03 cm / s); Vmin on the right 8 cm / s, Vmin on the left 9.5 cm / s, (norm 17.9 ± 0.02 cm / s) duration of emissions on the right 1300 msec, on the left 2533 msec).

Electromyostimulation was performed to improve the urodynamics of the upper urinary tract. Directly during electrical stimulation, the urine velocity in the ureter was determined. Using ultrasound, the velocity of ureteral ejection was determined (Vmax on the right and left in cm / s, Vmin on the right and left in cm / s), the frequency of ureteral contraction (Hz or once per minute) and the general functional state of the kidneys and ureters.

An electrically conductive gel was applied to the electrodes for electromyostimulation. Then electrodes were placed on the patient, one of which was placed in the pubic bone region, and the others were placed paravertebrally along the outer edge of the muscle that straightens the spine, in the area between the XII rib and the sacral region. After that, the applicator of the ultrasound machine was placed in the ureter and the electric myostomulator was turned on: signals with a channel switching frequency of 3-30 Hz, a pulse frequency in a packet of 5 kHz, a pulse amplitude of 12 V, a pulse duration of 0.1 ms were fed to the paravertebral electrodes. In this case, the initial value of the channel switching frequency was 3 Hz. Then, again by means of ultrasound, the velocity of ureteral ejection was determined (Vmax on the right and left in cm / s, Vmin on the right and left in cm / s), the frequency of contraction of the ureters (Hz or once per minute). Then the frequency of channel switching was increased to 30 Hz using a potentiometer, and ultrasound was repeated. The total time of electromyostimulation was no more than 6 minutes. The electromyostimulation apparatus was turned off, the ultrasound applicator and electrodes were removed.

An increase in the velocity of urine in the ureter to 49.8 cm / s was found, that is, the velocity indicators approached normal values. The repetition rate of impulses of contraction of the ureter in this case is 0.83 Hz.

After the course of electrical stimulation, a control study of the urodynamics of the upper urinary tract was carried out by determining the ureteral emissions. It was found that both maximum and minimum velocities increased Vmax on the right 40.2 cm / s, Vmax on the left 46 cm / s, Vmin on the right 14 cm / s, Vmin on the left 16.2 cm / s, the duration of emissions on the right 1300 msec, on the left 1533 msec.

Similarly to that described in example 1, a survey was conducted of children with chronic pyelonephritis, a total of 25 people aged 5 to 15 years.

It was found that after the course of electromyostimulation, the rate of ureteral ejection increased by 25-30%, while the duration of the ureteral ejection in most cases reached normal values. In the comparison group in children with chronic pyelonephritis who did not receive myostimulation, the indicators of ureteral emissions did not change.

In the study of the urodynamics of the upper urinary tract (UTI) in children with chronic pyelonephritis, it was found that the amount of ureteral emissions per minute in 75% of children varied within normal limits, for 13% it was increased and for 12% it was reduced. In 90% of children, there was a decrease in both the maximum and minimum velocities of ureteral ejection, as well as the velocity of urine in the ureter, in 4% of children there was an increase in the velocity indices of ureteral ejection, and for 6% of children, normal velocity indices were recorded.

When assessing the speed indicators, the difference between the ejection speed on the right and left was not revealed. Indicators in different groups of children did not differ significantly. The duration of ureteral ejection was reduced for 58% of children, increased for 26%, and was normal only for 16%. In most cases, children showed a decrease in the velocity characteristics of ureteral emissions, as well as a decrease in the duration of the ejection, which indicates a decrease in the contractile and evacuation capacity of the upper urinary tract, i.e. hypotension of the ureters. The research results are presented in table 1.

Table 1

Doppler indices of ureteral output in children with pyelonephritis before and after electromyostimulation

Age Vmax average, cm / s before stimulation Vmax average, cm / s after stimulation Vmin average, cm / s before stimulation Vmin average, cm / s after stimulation 5-10 years 17.2 20.6 7.2 8.6 10-13 years old 15.5 18.6 3.8 4.56 13-15 years old 32 36.8 8.5 9.7

FIG. Figures 2 and 3 present the results of studies of one of the patients - patient M, 11 years old before and after electrical stimulation.

FIG. 2 shows that the urine velocity directly in the ureter is 24.9 cm / s. Additionally, the frequency of repetition of impulses of contraction of the ureter was determined, in this case it was about 0.45 Hz or 27 contractions per minute (indicated by arrows in Fig. 2).

Then, under the control of the ureter by ultrasound, electromyostimulation was performed at a channel switching frequency of 3 Hz.

From FIG. 3 it can be seen that the urine velocity in the ureter was 49.8 cm / s, the repetition rate of the ureteral contraction impulses in this case was 0.75 Hz or 45 contractions per minute. An increase in the frequency of channel switching up to 30 Hz caused an increase in the velocity of urine movement in the ureter and in the repetition rate of impulses of ureteral contraction. A decrease in the frequency of channel switching to less than 3 Hz caused the emergence of a risk of reflux and reverse flow of urine into the kidney due to the asynchronous external influence and the natural frequency of ureteral contractions.

Thus, the proposed method for restoring the urodynamics of the upper urinary tract allows you to restore the tone, contractile and evacuation ability of the upper urinary tract, which reduces the duration of exacerbation and the number of exacerbations of pyelonephritis, which are associated with impaired urodynamics. This method is non-invasive, which allows it to be used in pediatrics, as well as not only in a hospital setting, but also in outpatient practice.

Claims (2)

1. A method of electrical stimulation of the ureter, including the excitation of electrical oscillations in the patient's body with the help of electrodes, one of which is located in the pubic bone, and the others are paravertebral along the outer edge of the muscle that straightens the spine, in the area between the XII rib and the sacral region, and supply sequentially to each paravertebrally located electrodes towards the sacral region of a pulse signal formed in a pack, characterized in that a signal with an amplitude of 12 V is supplied, the pulse repetition rate in the pack is chosen 5 kHz, the repetition rate of the packs is chosen 3-30 Hz, while the packs of pulses are supplied continuously ... 2. The method according to claim 1, characterized in that the excitation is carried out for 3-5 minutes, once a day for 5-20 days.

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