RU2762206C1 - Method for diagnosing delayed bladder defects in maternity patients after cesarean section surgery - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely obstetrics and gynecology, and can be used to diagnose delayed bladder defects in maternity patients after cesarean section surgery. Cystography is performed. At the same time, after the contrast is introduced retrogradely into the bladder, the patient is placed on her stomach. After 5-7 minutes, a spiral CT scan is performed. When visualizing a contrast agent outside the bladder, a bladder defect is diagnosed in the area of the postoperative suture.EFFECT: method makes it possible to identify delayed small defects of the bladder by laying the patient on her stomach.1 cl, 3 dwg, 2 ex

Description

The invention relates to medicine, namely to the specialty of obstetrics and gynecology, and can be used to diagnose defects of the bladder during cesarean section operations in the postoperative period.

Analogs

There is a known method for diagnosing bladder defects - cystoscopy, which consists in introducing a cystoscope into the urethra, into the bladder, which is filled with saline, and then the bladder walls are examined. (Lopatkin N.A., Textbook on urology 1995, 146 pp. Publisher: Medicine ISBN: 5-225-00971-9, Moscow)

Analogue criticism

The disadvantage of this method is the inability to visualize small defects in the suture area after cesarean section, since the defect is covered by edematous tissues.

Analogs

There is a known method for diagnosing bladder defects - descending cystography, for this, a radiopaque substance is injected intravenously, after which, after a certain time, the bladder is filled with saline and X-rays are taken. The disadvantages of this method are low resolution, the inability to visualize small defects in the suture area after cesarean section. (Radiation diagnostics: textbook: T. 1, under the editorship of Prof. G.E. Trufanov. 2011).

A known method for diagnosing bladder defects is magnetic resonance imaging, using renal-excreted contrast agents. The method has a high resolution. (Magnetic resonance imaging: a handbook. Westbrook K., Publisher: Knowledge Laboratory, ISBN: 5906828451, ISBN-13 (EAN): 9785906828453, 400 pp., 2018).

Analogue criticism

The disadvantages of this method are: 1) visualization of a small defect without changing the position of the patient and tight filling of the bladder is not possible, since the postoperative suture is edematous and the edges of the defect cover the hole,

2) the duration of the study (20-30 minutes in one position),

3) tight bladder filling is difficult for postoperative patients for a long time,

4) the high cost of the study and contrast agent (gadodiamide, omnisan 10 pcs, 20 ml each - 26800 r and higher compared to the radiopaque urografin 10 amp. 20 ml each 2445 r.

Invention prototype

As a prototype, we took the method described in the textbook on urology Lopatkina N.A. (Lopatkin N.A. Textbook on urology 1995, 146 pp. Publisher: Medicine ISBN: 5-225-00971-9, Moscow).

The closest in purpose and set of essential signs is a method for diagnosing bladder defects - retrograde (ascending) cystography, which consists in producing an X-ray image of the bladder after filling it with a contrast agent using a catheter. Typically, cystography is performed with the patient in the supine position with the hips abducted and bent in the hip joints. To obtain a spatial representation of the internal contours of the bladder, cystography is performed in three mutually perpendicular directions: axial, right and left oblique. Retrograde (ascending) cystography allows you to determine the type of damage and, by the location of urinary leaks, its approximate localization. The leakage of contrast agent into the abdominal cavity is detected in 83.3%. However, in 16.7% of patients, even tight bladder filling, images in 2-3 projections and a postponed image after emptying the bladder do not reveal streaks and other signs of damage.

Criticism of the prototype:

The disadvantages of this method are:

- low resolution.

- in 16.7% of cases, no streaks are detected.

- does not reveal the localization of the defect.

Purpose of invention

The aim of the invention is to improve the efficiency of diagnosis of delayed defects of the bladder in puerperas after cesarean section, and to reduce the frequency of urinary peritonitis. The aim is to detect a defect from 1 mm in delayed scanning of the bladder in the area of the postoperative suture.

The essence of the invention

The essence of the invention is illustrated in FIG. 1, fig. 2, fig. 3, where pos. 1 - bladder, pos. 2 - defect, pos. 3 - contrast outside the bladder.

The proposed method produces a retrograde tight filling of the bladder (pos. 1) with a contrast agent (urografin) diluted in saline in a ratio of 1:10, in an amount of 150-250 ml. Then, a delayed scan is performed 5-7 minutes later using a spiral computed tomograph in the patient's prone position, for maximum compression of the bladder by the postpartum uterus and the isolation of contrast from small defects (fistulas) of the bladder in the suture area. In the presence of a defect (pos. 2) from 1 mm of the bladder in the area of the postoperative suture, the contrast (Fig. 1. pos. 3) is visualized outside of it.

Clinical example 1

1. The postpartum woman M. is 27 years old.

After a cesarean section on the 3rd day, erythrocytes (microhematuria) appeared in the urine analysis. To detect defects in the bladder, a retrograde tight filling of the bladder with a contrast agent (urografin) diluted in saline in a ratio of 1:10, in an amount of 250 ml, was performed. Then, a delayed scan was performed 5 minutes later using a spiral computed tomograph in the patient's prone position; small-point defects were identified along the posterior wall of the bladder in the region of the postoperative suture on the uterus with visualization of the contrast agent outside of it in the paravesical tissue. Conducted conservative treatment, long-term catheterization of the bladder, the patient was discharged in a satisfactory condition on the 9th day. No complications were found in the late postoperative period.

The performed diagnostics made it possible to identify a delayed bladder defect in a postpartum woman after a caesarean section, and to eliminate the danger of urinary peritonitis and the formation of bladder fistulas.

The results of the treatment have confirmed that the aim of the invention has been achieved.

Clinical example 2

Postpartum N., 30 years old.

After a cesarean section, on the 4th-5th day, a low-grade fever, moderate pain on palpation of the abdominal cavity appeared, an ultrasound examination revealed a small amount of fluid in the abdominal cavity, without any peculiarities in laboratory tests. To detect defects in the bladder, a retrograde tight filling of the bladder with a contrast agent (urografin) diluted in saline in a ratio of 1:10, in an amount of 250 ml, was performed. Then a delayed scan was performed 5 minutes later using a spiral computed tomograph in the patient's prone position. On the sagittal and axillary tomograms, a defect in the bladder wall up to 3 mm (Fig. 1, 2, 3; pos. 2) with a contrasting fluid flowing towards the uterus is determined. (Fig. 1, 2, 3; pos. 3)

Intensive conservative treatment, adequate antibiotic therapy, prolonged catheterization of the urinary bladder were carried out, the patient was discharged in satisfactory condition on the 9th day. No complications were revealed in the late postoperative period. The performed diagnostics made it possible to identify a delayed bladder defect in a postpartum woman after a caesarean section, and to eliminate the danger of urinary peritonitis and the formation of bladder fistulas.

The results of the treatment have confirmed that the aim of the invention has been achieved.

Distinctive features of the prototype and invention

Prototype

1. Reveals urinary leakage with large defects.

2. Does not detect localization of defects.

3. Low resolution.

4. Retrograde X-ray contrast cystography.

5. Scanning immediately after the introduction of contrast and after emptying the bladder.

Invention

1. Reveals defects from 1 mm.

2. Reveals the localization of defects.

3. The use of retrograde spiral computed tomography, with high resolution (slice up to 0.5 mm).

4. 5-7 minutes exposure after the introduction of contrast in the prone position before scanning.

Clinical application

The proposed method for the diagnosis of delayed bladder defects in postoperative women after repeated cesarean section, with technical difficulties during the operation and in the postoperative period, there were signs of bladder defects.

(To exclude intraoperative damage, all women are diagnosed with bladder injuries during surgery).

Defects with a diameter of 1 to 7 mm were found in 15 patients, followed by conservative treatment (insertion of a urinary catheter and prescription of antibiotics), after 7-9 days the patients were discharged after control X-rays without signs of a defect.

Characteristics of medico-economic efficiency:

1. Efforts to reduce the occurrence of urinary peritonitis.

2. Achieved reduction of septic complications in puerperas.

3. EFFECT: reduced long-term consequences - formation of urinary fistulas.

4. Relatively low consumption of materials and medicines.

The technical result of using the proposed method

EFFECT: method allows to reveal small delayed bladder defects from 1 mm to carry out conservative treatment with catheter insertion upon detection of a defect for 5-9 days to create conditions for defect healing, thereby reducing the frequency of urinary peritonitis and bladder fistula formation.

The study time for the proposed method is no more than 6-8 minutes: 5-7 minutes for exposure of a contrast agent, lying on the stomach, and 15 seconds scanning using a spiral computed tomograph.

Spiral computed tomography has a high resolution (0.5 mm slice).

The contrast agent urografin used in spiral computed tomography is affordable.

Information taken into account:

1. 1. Mortelmans D., Messaoudi N., Jaekeis J., Bestman R., Pauli S., Van Cleemput M. Laparoscopic repair of intraperitoneal bladder rupture after blunt abdominal trauma. // J Urology 2014. Vol. 11, no. 1. P 1338-1340.

2. 2. Zeldovich Ya.B. Quote: after A.V. Lyulko. Damage to the organs of the genitourinary system. Kiev: Health, 1981.77 p.

3. 4. Dovlatyan A.A., Cherkasov Yu.V. Traumatic injuries of the bladder: tactics and results of treatment. Urology 2004; (6): 30-34.

4. 5. Sidorov V.A. Staged treatment of victims with wounds and closed injuries of the bladder: Abstract of the thesis. dis. ..cand. honey. sciences. M., 2001.24 p.

5. Davidov MI, Gerner AO, Nikonova OE, Algorithm for the diagnosis and treatment of intraperitoneal bladder rupture, Experimental and Clinical Urology, 2016; 4.

6. V.F. Chikaev, I.F. Akhtyamov, R.A. Ibragimov. Modern principles of diagnosis and treatment of bladder injuries in concomitant trauma. December 2011; 7 (55), 154-156.

7. Lopatkin N.A., Textbook on urology 1995, 146 p. Publisher: Medicine ISBN: 5-225-00971-9, Moscow - prototype.

Claims (1)

A method for diagnosing delayed bladder defects in postpartum women after cesarean section by cystography, characterized in that after the contrast is injected retrogradely into the bladder, the patient is placed on the stomach and after 5-7 minutes scanned with a spiral computed tomography and when visualizing the contrast medium outside the urinary bladder in the area of the postoperative suture, a defect of the bladder is diagnosed.

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