SU1156660A1 - Method of treatment of male vesicourethral segment organs - Google Patents

Abstract

A method for treating diseases of the bladder-urethral segment in men, including local administration of drugs, massage of the seminal vesicles, antibacterial, enzymatic and hormonal therapy, characterized by the fact that, in order to increase the duration of treatment and to increase remission, they can get a rhythmic therapy. the duct after its exposure and antegrade bougienage and local drug injection is carried out through the catheter, which is removed after the end of treatment.

Description

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ABOUT)

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The invention relates to medicine, specifically to urology, and is intended for the treatment of diseases of the vesicourethral segment in men, such as vesiculitis, prostatitis, posterior urethritis, colliculitis, as well as for the prevention and treatment of complications after adenomectomy, such as bleeding from a remote adenoma and exacerbation of the inflammatory process in the seminal vesicles and in the bed of prostate adenoma.

The purpose of the invention is to reduce the duration of treatment and increase remission.

The method is carried out as follows.

A powerful branch of the outflowing canal is 3–4 cm long, transverse incision of the duct is made up to half its thickness, the lumen of the duct is antegrade for 4–5 cm, and a catheter is installed, which is fixed to the duct by two circumferential chrome-knot nodes. The ends of the nodes are padded to the muscular membrane and are pairwise bonded, and the outer end is fixed to the skin with a chromketgut thread. The most accessible, from the point of view of surgical manipulations, is the powerful branch of the vas deferens. The length over which the drift bone is placed (4–5 cm) allows it to be securely fixed by two twists.

In the treatment of chronic vesiculoprostatitis complicated by colliculitis and posterior urethritis, retrograde instillations of the urethra are excluded. 10-15 mg of chymotrypsin for 2.5-3.0 ml of hypertonic solution are administered 2-3 times a day for the established catheter for 3 days, and massage the seminal vesicle 50–60 minutes after each injection. At the end of the course of administration of chemiotrypsin, a antibacterial drug is administered (according to the antibiogram) in an amount of 500 thousand - 1 million units. in 18-20 ml of hypertonic solution for 8-10 minutes 6-8 times a day for 5-6 days or until the sterility of the washing liquid is obtained. Thereafter, 14-15 mg of prednisone in 9-10 ml of the solvent, 3-4 times a day for 3 days, are administered by difenerostomy.

For the treatment of vesiculoprostat, it is sufficient to administer 2-3 times a day for 3 days chymotrypsin in the amount of 2.5-3.0 ml, 6-8 single injections of an antibacterial drug in the amount of 500 thousand - 1 million units. for 5-6 days, as well as prednisone in the amount of 14-15 mg in 9-10 ml of solvent for 3 days 3-4 times a day. With the introduction of chymotrypsin in the amount of solvent less than 2.5-3.0 ml, the therapeutic effect does not occur, which is caused by insufficient enzyme penetration into the seminal vesicle, and the use of more than 3.0 ml of solvent leads to the drug entering the posterior urethra, which has an unnecessary irritant effect. . The indicated amount of antibiotic solvent is needed to enter the posterior urethra, with an amount of 18-20 ml creating the desired concentration in the seminal vesicles and in the posterior urethra. For medicinal effect on the bed

0 remote prostate adenoma in patients with chronic vesiculoprostatitis in the early postoperative period (after removal of the urethral catheter) for 2-3 days against the background of general antibacterial therapy, as in the known method, local medicinal effects on the bed and vesiculitis begin, but not through cystothermic drainage , and through constant dripstomy. Using them 3 times a day with an interval of 6-8 hours is administered drip into

0 for 50-60 min. The medicinal mixture in the amount of 250.0 ml for each surfactant containing, on 100.0 ml, a 0.25% novocaine solution 1.0-1.5 ml, 0.25% mezaton, 1, 0-1.5 ml of aloe extract, 1.0-1.5 million units. antibiotic according to anti5 biogram. After each injection, a gentle massage of the seminal vesicles is performed. These procedures continue until self-urination is restored. At the end of their time, 18-20 ml of 0.25% is administered over each 5 minutes for each 5 minutes

 solution of novocaine containing 500 thousand. 1 million units. antibiotic, according to the antibiogram 6–8 times a day until the microbial contamination of the wash water disappears. Then, using driptoceostomy 3-4 times a day for 2-3 days, 14-15 mg of prednisolone is introduced into 20-18 ml of a 0.25% solution of novocaine in 5 minutes. Stomas are removed. The treatment of patients after adenomectomy with hruchnic vesiculoprostatitis in this way can be started only after the removal of the urethral catheter (2-4 days after surgery), since it prevents the release of the drug mixture from the semen ducts into the urethra and further into the bladder.

In order to reliably prevent the possibility of bleeding, it is enough to inject mezaton in 250.0 ml of solution in the calculation of 1 ml of 0.25% solution of mezaton per 100.0 ml of novocaine for 50-60 minutes 3 times a day.

„To each drintostomy.

To conduct effective local antibiotic therapy, it is sufficient to add an antibiotic to the injectable fluid according to the antibiogram in the calculation of 1 million units. for every 100.0 ml of novocaine. Adding aloe extract in the amount of 1.0-1.5 ml for every 100.0 ml of novocaine improves the regenerative capacity of tissues.

Drip injection of 250.0 ml of novocaine solution according to x-ray control is best done in 50-60 minutes, then the seminal vesicles do not overgrow, and long-term local drug exposure is possible.

The introduction of a 0.25% solution of mezaton in an amount of less than 1.0-1.5 ml per 100.0 ml does not provide the necessary vasoconstrictor effect, the introduction of it in large quantities can lead to pronounced vasoconstruction and impaired healing processes. The recommended massage of the seminal vesicles allows them to be freed from inflammatory exudate and cause contraction.

After self-urination has been restored in patients after adenomectomy with vesiculoprostatis, microbial seeding of the seminal vesicle washing fluid, bed and bladder, as a rule, remains. The optimal treatment is the 6-8 times the administration of the antibiotic according to the antibiogram in the amount of 500 thousand - 1 million units. in 20.0-18.0 ml of a 0.25% solution of novocaine for each detentrostomy. The rate of administration for 5 minutes does not cause overgrowth of the seminal vesicles (radiological control was performed), and the amount of solvent allows irrigating not only the seminal vesicles, but also the posterior urethra and bladder, creating the necessary concentration of the antibiotic.

The introduction of prednisolone in the amount of 14-15 mg in 18-20 ml of a 0.25% solution of novocaine after 5 minutes for 3 days after the administration of driphenosthoma prevents the possibility of recurrence of inflammation caused by autoimmuno-conflict.

For medicinal action on the bed of a remote prostate adenoma, not complicated by vesiculoprostatitis, in the early postoperative period (after removal of the urethral catheter) for 2-3 days against the background of general antibacterial therapy, as in the known method, local treatment of the bed of the removed prostate gland is started, but not through cystostomy drainage, but through permanent stomas that are installed antegradely in the scrotal sections of the seed ducts during the operation. 3 times a day, with the interval of 6-8 hours, the medicinal mixture in the amount of 250.0 ml for each deferenostomy containing 100.0 ml of a 0.25% solution of novocaine 1 is injected dropwise for 50-60 min. 0-1.5 ml of 0.25% mesatone, 1.0-1.5 ml of aloe extract, 1-1.5 million units. antibiotic (according to the antibiogram). After each injection, a gentle massage of the seminal vesicles is performed. These procedures continue until self-urination is restored. Stomas are removed. Treatment of patients after adenomectomy according to the proposed method can be started only after removing the urethral catheter from (2-4 days after surgery), since it prevents the drug mixture from being released from the ejection duct into the urethra and further into the bladder.

Conducted clinical observations have shown that in order to reliably prevent the possibility of developing postoperative bleeding, it is sufficient to introduce mesaton in a 250.0 ml solution in a calculation of 1.0-1.5 ml of a 0.25% solution of mesatone per 100.0 ml of novocaine for 50- 60 min 3 times a day for each detentrostomy.

To conduct effective local antibiotic therapy, it is sufficient to add an antibiotic to the injectable fluid, according to the antibiogram, in the calculation of

0 1 -1.5 million units for every 100.0 ml of novocaine. Adding aloe extract in the amount of 1.0-1.5 ml improves the regenerative capacity of tissues.

Drip injection of 250.0 ml of novocaine solution is best carried out according to the X-ray monitoring data per minute, then the overgrowth of the seminal vesicles does not occur and there is the possibility of long-term local drug exposure.

The introduction of 0.25% mesaton in the amount of 1.0-1.5 ml per 100.0 ml does not provide the necessary vasoconstrictor effect, the introduction of it in larger quantities can lead to pronounced vasoconstruction and disruption of the healing process of laziness.

A recommended massage of the seminal vesicles allows them to be released from the inflammatory exudate and cause their reduction.

Example 1. Patient A., 42 years old, suffers

0 2 g Chronic vesiculoprostatitis. In order to conduct local long-term therapy, he decided to install a permanent catheter into the right vas deferens. Under local anesthesia and conduction anesthesia with a 2% solution of novocaine, the spermatic cord is fixed by hoes. The dissection of the scrotal skin 3 cm long is made below. Semen duct is separated by layers over 4 cm in a blunt and sharp way. Put a catgut "holder on the lower part of the selected section of the duct. Scalpel in the transverse direction until the appearance of the lumen nicked duct. The lumen was antegradely bougiened with an angiographic guide for a length of 4 cm. A catheter with a diameter of 400 μm was held in a duct for 4 cm.

X-ray control. The catheter with two chromeketgut obvivnymi nodes fixed to the duct. Ends of these threads

hemmed to a mega sheath and linked in pairs. One chromeketgut seam on the skin, to him fixed defentostomy. Iodine sticker. Treatment for 12 days. There were no complications associated with the installation of the catheter.

Example 2. Patient P., 58 years old, has suffered from chronic prostatitis for several years, without succumbing to treatment. History - repeatedly renal colic on the left. Examination: on the excretory urogram - expansion of the ureter and cup-pelvis-plating system on the left with narrowing of the ureter in its lower third, palpation - sharply increased seminal vesicles, painful, in their secret - pronounced bacterial inflammation, on the vesicles there is a sharp expansion, ducts passable. Treatment by the proposed method. Complaints disappeared. On the control extrethral urogram, there is no extension on the left. Duration of treatment is 12 days. Observation within 5 months - no recurrence.

Example 3. Patient D., 71 g., With prostate adenoma, multiple bladder stones, pronounced prostatic anesthesia. The diagnosis was confirmed by X-ray and laboratory diagnostic methods. On vesicles, the seminal vesicles are dramatically expanded, the patency of the ducts is preserved, but there is a narrowing of the semen ejecting its duct from both sides. In urine tests.

the secret of the prostate, the secret of the seminal vesicles pronounced microbial seeding. After adenomectomy, the urethral catheter was removed on the 2nd day and treatment was started on

the proposed method. By 1U, a significant effect was noted - the amount of flora in the washing liquid decreased 10 times, the cytological picture of the healing of the bed. Self urination restored. By the 16th day of treatment in the crop

no growth washing liquid. The term of observation is 2 months. The clinical effect is persistent.

Example 4. Patient K., 58 years old, with prostate adenoma. The diagnosis is confirmed by clinical research methods. In the prostate secretion 8-10 leukocytes. On vesicular seminal vesicles moderately dilated, ducts of normal diameter. There is no data on inflammation in their washing liquid (dyenerostomy is superimposed before the operation). There is no growth in the urine. Produced adenomectomy. From the 2nd day of the treatment by the proposed method. The moderate hematuria that occurred since the operation was stopped 10 minutes after

start the mixture. Not repeated throughout the course of treatment. Postoperative bacteriuria (100 thousand) was eliminated by the 7th day of treatment. Therapy is up to 11 days, after which the independent urination is restored. The term of observation is 2 months. The effect is persistent.

Claims (1)

METHOD FOR TREATING DISEASES OF BODY-URETHRAL SEGMENT BODIES IN MEN, including local administration of drugs, massage of seminal vesicles, antibacterial, enzymatic and hormonal therapy, characterized in that, in order to shorten the duration of treatment and increase remission, they establish a permanent catheter after this exposure and antegrade bougieurage and local administration of drugs · carried out by catheter, which is removed after treatment. >