SU1731223A1 - Method for treatment vesicoureteral reflux of children - Google Patents

Abstract

This invention relates to medicine, in particular to pediatrics and urology. The goal is to shorten the treatment time while reducing the complications of the procedure. To do this, when performing cystoscopy, the cyanacrylate glue MK-2 in a volume of 0.3-1 ml and a solution of cerucal in an age-old dose are injected in the submucosal layer of the ureter. With simplicity, minor trauma and short duration, the method allows to reduce the treatment, the patient's stay in the hospital, without disrupting the maturation process of the vesicoureteral segment in children.

Description

This invention relates to medicine, in particular to pediatrics and urology.

The goal is a reduction in the duration of treatment and a reduction in complications.

The method is carried out as follows.

Children with vesicoureteral reflux (PMR) under general anesthesia (ketamine, fluorothane, etc.) during cystoscopy under the submucosal ureter are injected with a needle-catheter cyanacrylic glue from 0.3 to 1 ml depending on age child, after that, Tseklakl is administered according to a single dose of the child, depending on age. The needle-catheter consists of the ureteral boat No. 5 on the Charriere scale and the needle located in its end part from a record-type syringe for intramuscular administration, which is crossed in the end part (2 cm left). At the same time, 1 cm is inserted into the lumen of the catheter, and the sharp (stabbing) part of the needle protrudes 1 cm from the catheter. With a retrograde cystoscope

In the course of the catheter, a needle-catheter is inserted into the submucosal section under the ureter for 6 hours at a depth of 1 cm. For stiffness of the needle of the catheter, a wire mandrel of the given catheter is inserted into its lumen before insertion. Before insertion of the needle, the entire system, which is in contact with the adhesive later, is treated with a solution of glycerin, which is removed from the lumen of the needle-catheter, leaving only its inner walls. This is necessary for good glueing. After inserting the needle under the ureter, the mandrin is removed, the catheter is attached to the syringe for single use up to 1 ml, which is connected to the catheter via an intermediate needle. Under visual control, MK-2 cyanoacrylate glue was injected through the cystoscope, another syringe was attached and the needle was inserted, the cerucal solution was dispensed in the age dosage, then the needle catheter was removed from the bladder. Visually, this indicates

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the position of the submucosal ureter, ust, as if on a roller.

After manipulation, the patient is prescribed abundant drinking (cranberry or lingonberry juice), diuretic (furosemide in 5 age dosages), which provides increased diuresis through the cystic urinary segment (PMS). 3-4 days after the administration of medicinal substances, in the absence of any pathological manifestations (temperature, dysuria, pain syndrome, etc.), a control cystography is made to the patient, which is repeated after 3-6 months from the moment of administration. For the effectiveness of the ICP 15 evacuation function, monitoring is carried out using ultrasound echolocation or radioisotope renography. After the cystography, the patient is discharged from the hospital and further observation is carried out on an outpatient basis.

Endoscopic correction of TMR in children is carried out only after long-term conservative treatment and rehabilitation of patients (from 6 months to 3 years), when the question of its ineffectiveness and the need for surgical treatment of TMR is raised.

Cyanacryl glue MK-2, introduced under the ureter, has a tendency to dissolve after a certain period of time (1-6 months), which eliminates its long-term effect on PMS.

The additional administration of cerucum provides a pronounced stimulatory effect on the ureter and the vesicoureteral effect. The introduction of cerucul into the glue lump, which immediately polymerizes, allows to obtain a modified effect of 40

pharmacodynamic drug, i.e. It acts as a gummy lump dissolves.

PRI me R 1. Sick S., 4.8 years. Diagnosis: III-IV degree reflux from 2 to 45 prs. Secondary pyelonephritis, remission. Sick for 1.5 years (leukocyturi, dizuri, etc.). Despite the ongoing conservative treatment, progression of reflux is noted.50

Endoscopic reflux correction was performed according to the proposed method (0.5 ml of MK-2 cyanoacrylate glue and 0.4 ml of cerucal were inserted under the ureter on the left). The control-55 examination was carried out on the 4th day after administration and after 3 months. Reflux on the left is not noted, and reflux on the right is reduced to grade II. When ultrasound examination of the kidneys, hydronephrotic transformation was not observed.

PRI mme R 2. Ill P., 5 years. Diagnosis: reflux III degree in the double kidney on the left. Secondary pyelonephritis, remission. Ill for 2 years (periodic exacerbations of pyelonephritis - 3 times a year), despite continuous conservative reflux therapy persists (reflux to the double kidney).

Endoscopic reflux correction was performed according to this procedure (0.7 ml of MK-2 cyanoacrylate glue and 0.5 ml of cerucal were injected). Control examination in time for the 2nd day after drug administration and 6 months after administration. There is no reflux. Renography and ultrasound echolocation were performed. No pathological changes from the upper urinary tract were identified.

The method was applied in 11 sick children with HUR of IIHV degree.

Endoscopic reflux correction is less traumatic compared to the operation, it is used especially in young children, which does not disrupt the natural maturation process of the vesicoureteral segment.

The introduction of cyanoacrylate glue under the reader, taking into account its tendency to resorption within 6 months, allows normalizing the function of the ICP and does not significantly alter the maturation process, which radically distinguishes it from the known method, where Teflon is used.

The introduction of cerucal in combination with glue allows prolonging the stimulating effect of cerucal on the ICP, due to its gradual release from the absorbable adhesive lump.

The simplicity and accessibility of manipulation and drugs allows this reflux correction method to be widely used.

The short duration of manipulation and its low injury rate dramatically reduces the patient's stay in the hospital, which is economically advantageous (patients stay in the hospital for 4-5 days).

Claims (1)

Invention Formula A method of treating vesicoureteral reflux in children, which includes the introduction of therapeutic agents into the submucosal layer of the ureter during cystoscopy, characterized in that 3-1 ml and the solution of cerucal in the age-old single dose.