RU2803133C1 - Method of the treatment of neuromuscular dysfunction of the bladder - Google Patents

Abstract

FIELD: medicine; neurology; traumatology; urology; gynecology; andrology; oncology.

SUBSTANCE: invention can be used to treat neuromuscular bladder dysfunction. Local air cryotherapy of the lumbosacral spine at the level of the vertebrae T12-L1 and S1-S3 is performed. Local air cryotherapy of the head is initially performed at the level of bregma for 2–3 minutes. Then, local air cryotherapy of the back surface of the neck is performed at the level of the C1-C2 vertebrae for 2–3 minutes. Air flow temperature is -40°C, air flow rate is 900–1,100 l/min, course of treatment is 10–12 daily procedures.

EFFECT: method provides reduction and disappearance of symptoms of neuromuscular dysfunction of the bladder due to the use of local air cryotherapy.

1 cl, 2 ex

Description

The invention relates to medicine, namely to neurology, traumatology, urology, gynecology, andrology, oncology, and can be used to treat neuromuscular dysfunction of the bladder.

Neuromuscular dysfunction of the bladder is a term denoting various urination disorders that occur in the absence of regulation of the process by the nervous system and (or) smooth muscles of the urinary tract and can be caused by various diseases and pathological conditions characterized by disturbances in the nervous regulation of the lower urinary tract. The main clinical manifestations of neuromuscular dysfunction of the bladder: overactive bladder, hypoactive bladder, bladder outlet obstruction (Bely L.E., Solovyov D.A., Boluchevsky D.N. Pathogenesis of urodynamic disorders in bladder outlet obstruction of the urinary tract in patients with benign hyperplasia prostate // Siberian medical journal (Irkutsk). 2011; No. 5: 8-11.), detrusor-sphincter dyssynergia (Nikitin S.S., Guseva N.B., Nikitin V.S. Pathological physiology of detrusor-sphincteric dyssynergia in children // Russian Bulletin of Perinatology and Pediatrics. 2022; 67(5):89-95).

There is a known method for treating neurogenic bladder dysfunction in children (RU 2333016 C2, 2008). This method is carried out by electrical stimulation, with electrodes inserted paravertebrally to the sympathetic lumbar ganglia, stimulating the sympathetic trunks with an asymmetric rectangular biphasic current with a zero level direct current of 90 mA and a frequency of 120 Hz daily, 4-6 sessions for 10-14 days. There is a known method for the treatment of neurogenic bladder dysfunction (RU 2295364 C2, 2007), which consists of sacral neuromodulation, including search and puncture of the sacral openings using injection needles, while puncturing the right and left S3 sacral openings with the introduction of an alloplant solution into them. There is a known method of surgical treatment of patients with neurogenic dysfunction of the lower urinary tract and other diseases of the bladder (RU 2723462 C1, 2020). The main general disadvantages of the above methods are: the use of active invasive surgical tactics associated with the implementation of incisions or punctures of the skin and other anatomical structures. In addition, the introduction of electrodes into the patient’s body and the process of electrical stimulation (long-term) cause pain in patients, and surgical treatment is accompanied by anesthesia and long postoperative recovery. Carrying out a complex of invasive manipulations has a number of contraindications, in addition, it can lead to the development of complications (pro-injection, post-operative).

Non-invasive methods for treating neurogenic bladder dysfunction are known. For example, there is a known method that includes stimulating therapy with a pulsed laser of various parts of the body (RU 2609738 C1, 2017). However, the use of laser therapy has a large number of contraindications. In addition, there is a known method for the treatment of enuresis and neurogenic dysfunctions of the bladder in children (RU 2405593 C1, 2010). This method includes sequential exposure to a magnetic field on the paracentral lobes of the cerebral hemispheres on both sides, packs of bipolar electric current pulses on the cervicothoracic and lumbosacral segments of the spinal cord, the suprapubic zone, and radiation to the visual analyzer. However, exposure to a magnetic field has a large number of contraindications, for example, the presence of a pacemaker or metal objects in the human body. In addition, the method is limited to use only in children.

The closest prototype is a method for treating an overactive bladder (RU 2396920 C2, 2010). This method is carried out as follows. The patient is in a sitting position. Through a hose equipped with a replaceable nozzle, an air flow cooled to -40°C is supplied from the unit for air local cryotherapy (for example, CryoJet) to the patient's body from the back, with a volumetric air flow rate of 930-1080 l/min. In this case, sequential air cryotherapy of the lumbosacral spine is carried out at the level of vertebrae T12-L1 for 3-4 minutes and S1-S3 for 5-7 minutes. The course of treatment is 10-12 daily procedures. However, the method of treating overactive bladder is not applicable to the treatment of neuromuscular bladder dysfunction.

The essence of the proposed method for the treatment of neuromuscular dysfunction of the bladder, including the implementation of local air cryotherapy, is that sequential air cryotherapy is carried out on the head at the level of bregma for 2-3 minutes, on the back of the neck at the level of the C1-C2 vertebrae for 2-3 minutes, lumbar -sacral spine at the level of vertebrae T12-L1 3-4 minutes and S1-S3 5-7 minutes, air flow temperature -40°C, volumetric air flow rate 900-1100 l/min, air flow temperature -40°C, course of treatment is 10-12 daily procedures.

The method is carried out as follows. The patient is in a sitting position. Through a hose equipped with a replaceable nozzle, an air flow cooled to -40°C, a volumetric air flow rate of 900-1100 l/min, is supplied to the patient’s body from the back from a unit for air local cryotherapy (for example, CRIOjet Air C200, Germany). . In this case, sequential air cryotherapy of the head is carried out at the level of bregma for 2-3 minutes, the back surface of the neck at the level of the C1-C2 vertebrae for 2-3 minutes, the lumbosacral spine at the level of the T12-L1 vertebrae for 3-4 minutes and S1-S3 for 5- 7 minutes, air flow temperature -40°C, volumetric air flow rate 900-1100 l/min, air flow temperature -40°C, course of treatment 10-12 daily procedures.

Clinical examples.

Example 1.

Patient S., 52 years old. Main complaints. Impaired urination: decreased urge to urinate to complete absence, leakage of urine. Urine leakage increases with any physical activity: movement, coughing, sneezing, and sometimes when talking. Considers himself sick for 5 years. Over the last year, she has noticed frequent (almost constant) pain in the lower abdomen and a feeling of a foreign body in the pelvic area. History of hypertensive crises, episodes of cerebrovascular accident, polysegmental osteochondrosis. The therapy undertaken (laser therapy, physiotherapy, medication) was without effect. Frequent bladder catheterization was required to remove urine. Diagnosis: neuromuscular bladder dysfunction, hypoactive bladder. The patient underwent a course of local air cryotherapy according to the claimed method. 12 daily procedures were carried out. Tolerability is good. After treatment, there was a decrease in the severity of the main symptoms of the pathological condition of patient S. The main thing: the appearance of the urge to urinate (appearance after the fifth cryotherapy procedure according to the claimed method).

A feeling of residual urine appeared (a pathological symptom, but in this clinical case it may indicate improvement), pain in the lower abdomen decreased (in intensity) and became periodic. The general condition has improved. After a course of cryotherapy, urine leakage persisted, but occurred only during intense physical activity, for example, sneezing, lifting objects. It is recommended to conduct a second course of cryotherapy after 1 month. A second course of local air cryotherapy was carried out after 1 month. At the time of the second visit, the patient’s complaints about urinary disorders were much less pronounced than at the first visit (quantitatively and qualitatively). Repeated treatment demonstrated the stability of the clinical effect. 12 daily procedures were carried out. Tolerability is good. It is recommended to conduct a second course of cryotherapy after 2-3 months.

Example 2.

Patient P., 66 years old. The main complaints: frequent, unproductive urination at night (up to 5-8 times), a feeling of residual urine after urination, heaviness and discomfort in the groin area. With additional instrumental examination - transrectal ultrasound examination of the prostate gland (TRUS) - an increase in the volume of the prostate gland to 74 cm ³ , without focal pathology. Prostate specific antigen (PSA), total, 2.4 ng/ml. Diagnosis: benign prostatic hyperplasia. Overactive bladder syndrome. The patient received a course of treatment in accordance with the claimed method. 12 daily procedures were carried out. Tolerability is good. As a result, the patient's subjective condition improved significantly. The number of urinations at night has decreased to 1-2. During the study: the volume of the prostate gland with TRUS is 67 cm ³ . PSA (total) - 1.8 ng/ml. The feeling of residual urine after urination became inconsistent, heaviness and discomfort in the groin area did not bother me (after the fourth cryotherapy procedure). The general condition has improved.

96 patients aged from 40 to 68 years (37 women, 59 men) with clinical manifestations of neuromuscular dysfunction of the bladder were treated. All patients underwent a course of local air cryotherapy according to the proposed method, including sequential air cryotherapy of the head at the level of bregma for 2-3 minutes, the back of the neck at the level of the C1-C2 vertebrae for 2-3 minutes, and the lumbosacral spine at the level of the T12-L1 vertebrae 3-4 minutes and S1-S3 5-7 minutes, air flow temperature -40°C, volumetric air flow rate 900-1100 l/min, air flow temperature -40°C, course of treatment 10-12 daily procedures. Cryotherapy was well tolerated in all patients.

Thus, the use of the present invention makes it possible to provide treatment for patients with clinical manifestations of neuromuscular dysfunction of the bladder. The result of this treatment is the reduction and disappearance of symptoms of neuromuscular dysfunction of the bladder: decreased urge to urinate, complete absence of urge to urinate, inability to urinate, leakage of urine, pain in the lower abdomen and groin area, feeling of a foreign body in the lower abdomen, frequent urination during the day and at night, an irresistible desire to empty the bladder, a sharp and frequent urge to urinate, involuntary loss of urine when exerting.

The claimed method is easy to use, has no contraindications and does not cause complications.

Claims (1)

A method for the treatment of neuromuscular dysfunction of the bladder, involving the implementation of local air cryotherapy of the lumbosacral spine at the level of vertebrae T12-L1 and S1-S3, characterized in that initially local air cryotherapy of the head is carried out at the bregma level for 2-3 minutes, then local air cryotherapy of the back surface of the neck at the level of the C1-C2 vertebrae 2-3 minutes, air flow temperature -40°C, volumetric air flow rate 900-1100 l/min, course of treatment 10-12 daily procedures.