RU2304990C2 - Method for treating diseases of urinary bladder of inflammatory etiology - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: at first, it is necessary to wash urinary bladder's cavity with ozone/NO-containing physiological solution. Then, 1-3 min later one should evacuate the worked out solution and introduce ozonide/NO-containing butyric "oil-in-water" emulsion into urinary bladder's cavity. Cavitary sonication should be carried out through the solution with low-frequency energy at 26.5 kHz frequency and fluctuation amplitude being about 60-80 mcm for 1-2 min. The worked out solution should be evacuated. Urinary bladder's cavity should be refilled in with fresh solution of ozonide/NO-containing butyric "oil-in-water" emulsion. One should affect with low-frequency ultrasound at fluctuation frequency of 44 kHz and amplitude of 25-30 mcm due to external contact impact upon the tissues of anterior abdominal wall in area of urinary bladder's projection. Moreover, it is necessary to simultaneously bubble the emulsion solution with ozone/NO-containing gaseous mixture for 1 min followed by aeration of urinary bladder's cavity with ozone/NO-containing gaseous mixture for 1 min. Application of such complex therapy enables to decrease urethral traumatism , intensify regional blood and lymph circulation in the area of urinary bladder, create the depot of medicinal preparation in tissue layers of urinary bladder's wall and fulfill sanitation of urinary bladder's walls.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, in particular, can be used in the treatment of various diseases of the genitourinary system, for example, inflammatory and tumor etiology.

Known methods for the treatment of diseases of the bladder of inflammatory etiology, which include intravesical administration of a solution of a medicinal substance (antiseptic, antibiotic, etc.), soaking it in the bladder and subsequent evacuation of the solution [1].

However, the known methods are not effective enough due to:

- the duration of treatment, not excluding relapse of the disease;

- difficulties in the targeted delivery of the drug substance directly to the pathological focus;

- insufficient saturation of the bladder wall layers with a medicinal substance to create a depot of a medicinal substance in them with a high concentration, which provides a pronounced therapeutic effect.

The closest in technical essence and the achieved result is a method of treating bladder diseases of inflammatory etiology, which consists in the intravesical administration of a solution of a medicinal substance, exposure to a physical factor, such as direct current (intravesical iontophoresis), and subsequent evacuation of the spent solution [2].

However, this method is intended only for experimental studies in animals. The method is traumatic in relation to the urethra, because requires the use of a special catheter electrode and provides only unidirectional administration of a medicinal substance into one of the walls of the bladder adjacent to the anterior abdominal wall. In addition, this method does not provide the intensification of regional blood and lymph circulation of the bladder. In general, this method cannot ensure the effectiveness of the treatment of diseases of the bladder of inflammatory etiology, because it does not provide:

- high-quality sanitation of the walls of the bladder;

- the creation of a long-term depot of drug substances in the tissue layers of the entire wall of the bladder;

- initiation of pronounced anti-inflammatory, detoxifying, bactericidal, antihypoxic, vasodilating, analgesic, carcinogenic and other effects.

The objective of the invention is to increase the effectiveness of the treatment of diseases of the bladder of inflammatory etiology.

The objective of the invention is achieved by the fact that in the method of treating diseases of the bladder of inflammatory etiology, which consists in the intravesical administration of a solution of a medicinal substance, exposure to a physical factor and subsequent evacuation of the spent solution, primary rehabilitation of the bladder cavity is carried out by rinsing it with ozone / NO-containing physiological saline solution then, after 1-3 minutes, the spent solution is evacuated, after which ozonide / NO-content is injected into the bladder cavity oil-in-water emulsion and the sound of the cavity is carried out through the above intermediate solution of the emulsion with low-frequency ultrasound energy at an ultrasonic frequency of 26.5 kHz and an oscillation amplitude of the emitting end of the waveguide tool 60-80 μm for 1-2 minutes, and after The evacuation of the spent emulsion solution, the bladder cavity is again filled with a fresh solution of ozonide / NO-containing oil emulsion of the oil-in-water type and it is voiced with low-frequency ultrasound energy at frequent those ultrasonic vibrations of 44 kHz and the oscillation amplitude of the emitting end of the waveguide tool 25-30 μm by external contact in the area of the projection of the bladder on the tissue of the anterior abdominal wall with simultaneous bubbling of the solution of the emulsion ozone / NO-containing gas mixture for 1 minute, at the end contact scoring of the emulsion and its evacuation aerate the bladder cavity with an ozone / NO-containing gas mixture for 1 minute.

The analysis shows that when using known methods of treating bladder diseases of inflammatory etiology and technical means for their implementation, it is impossible to increase the effectiveness of treatment in this category of patients.

The method is based on the complex effect of ozone / NO-containing medicinal substances in different phase states on pathologically altered tissues of the bladder wall with the simultaneous intensifying effect of low-frequency ultrasound energy on metabolic processes in the system "solution of ozone / NO-containing medicinal substance - bladder wall tissue - the anterior abdominal wall is the radiating end face of the waveguide-tool, which provides pronounced hydrodynamic and mass transfer processes in the volume of the drug solution filling the cavity of the bladder, as well as in the regional blood and lymph systems of the bladder region, resulting in high-quality sanitation of the bladder cavity, impregnation of ozone / NO-containing medicinal substance in the tissue of the bladder wall, etc. Since ozone (O ₃ ) and nitric oxide (NO) are regulators of cellular functions and intercellular communications, as well as activators of NK lymphocytes (A.I. Soloviev, A.V. Stefanov, 1998), they make a significant contribution to the inactivation and destruction of a wide range of pathogenic microorg nisms and malignant transformation of cells. In addition, the proposed method is based on the specific physicochemical properties of liquid and gaseous ozone / NO-containing medicinal substances that provide pronounced anti-inflammatory, detoxification, bactericidal, antihypoxic, vasodilating, analgesic, antitumor and other clinically significant effects (Z. Rilling, P Fiban, 1985; V.V. Pedder et al., 1985, 2003; O.V. Maslennikov, K.N. Kontorshchikova, 2005, etc.).

The invention is illustrated by drawings, which depict:

figure 1 - diagram of the primary rehabilitation of the cavity of the bladder with ozone / NO-containing saline;

figure 2 - diagram of ultrasonic sanitation of the bladder cavity through an intermediate ozonide / NO-containing oil emulsion of the type oil-in-water;

figure 3 - diagram of the sound energy of low-frequency ultrasound ozonide / NO-containing oil emulsion of the type oil-in-water by external contact in the area of the projection of the bladder on the tissue of the anterior abdominal wall while sparging the bladder cavity of the bladder with ozone / NO-containing gas mixture ;

figure 4 - diagram of the aeration of the bladder cavity ozone / NO-containing gas mixture.

When implementing a method for the treatment of bladder diseases, ozone / NO-containing medicinal substances are used in the form of an ozone / NO-containing gas mixture with an ozone concentration of 3-5 mg / l, ozone / NO-containing physiological saline, ozonide / NO-containing 5-20 % oil emulsion of the oil-in-water type as the most clinically acceptable for creating bactericidal, fungicidal, virucidal and carcinocidal environments, as well as well-conducting ultrasound environments.

To implement the proposed method for the treatment of bladder diseases, the OHKOTOH-O3 / NO hardware complex is used (Figs. 1-4), which includes an ultrasonic generator 1 (for example, a commercially available ultrasound surgical device "CAVITON", Omsk), connected with an acoustic unit (ACU) 1.1, to which a two-wave peak waveguide-tool "peak" is attached with a radiating end face 1.2 beveled at a 45 ° angle; ultrasonic generator 2 (for example, the PROLONG ultrasound physiotherapeutic device manufactured in series, Omsk, Novosibirsk), connected to an acoustic unit (AKU) 2.1 with a developed radiating end face of 72 mm; a generator of ozone / NO-containing gas mixture 3 (for example, the ultrasound physiotherapeutic device “OZOTRON”, commercially available in Omsk), which is connected through a supply pipe 3.1, a three-way valve 4 and a pipe 5 with a capacity 6 containing ozone / NO-containing medicinal solution. In addition, the hardware complex "OHKOTOH-O3 / NO" contains a reamer-limiter 7 with a length of the working part of 10-12 cm and a perforated section of 3.5-5 cm, a cannula 8 with a perforated part at the working end 8.1 and the supply pipe 9, connecting cannula 8 with a three-way valve 4. The hardware complex "OHKOTOH-O3 / NO" is additionally equipped with an electrosurgical aspirator (not shown).

In this case, the ultrasonic surgical apparatus "CAVITON" generates low-frequency oscillations with a working frequency of ultrasonic vibrations of 26.5 kHz and an amplitude of oscillations of the emitting end of the waveguide-tool "peak" 0-100 microns. The physiotherapy apparatus "OZOTRON" generates an ozone / NO-containing gas mixture with an ozone concentration of at least 3-5 mg / l from atmospheric air. Physiotherapeutic ultrasound device “PROLONG” generates low-frequency range oscillations with a working frequency of ultrasonic vibrations of 44.0 kHz and an amplitude of oscillations of the emitting end of the waveguide tool 0-30 microns.

The proposed method for the treatment of diseases of the bladder of inflammatory etiology is carried out using the above hardware complex in stages.

After emptying the bladder in a position convenient for the procedure, a dilator-limiter 7 pre-oiled with ozonized oil is introduced into the urethra (for women) or in the postoperative suprapubic bladder fistula (for men), which is subsequently held in place by the patient.

After that, a cannula 8 is inserted into the central opening of the expander-limiter 7, connected through a delivery pipe 9, a three-way valve 4 and a pipe 5 with a capacity 6 filled with ozone / NO-containing physiological saline, deepening its perforated part at the working end 8.1 into the bladder cavity (figure 1).

Then, through the three-way valve 4, the bladder (through the supply pipe 9) is filled with ozone / NO-containing physiological saline, carrying out initial sanitation of the bladder cavity by intravesical flushing. After holding the solution in the bladder for 1-3 minutes, the ozone / NO-containing physiological solution is evacuated with an electrosurgical aspirator, the bladder cavity is again filled with ozonide / NO-containing oil-in-water emulsion, after which the cannula 8 is removed from the expander - limiter 7.

Next, through the expander-limiter 7, a waveguide tool 1.2 is introduced, connected with AKU 1.1, deepening its radiating end face into the bladder cavity (Fig. 2), turn on the ultrasonic generator 1 and sound the cavity for 1-2 minutes through an ozonide / NO intermediate solution -containing oil emulsion of the oil-in-water type at a frequency of ultrasonic vibrations of 26.5 kHz and an amplitude of oscillations of the emitting end of the waveguide tool 60-80 microns with ensuring its ultrasonic sanitation. At the end of ultrasonic sanitation of the bladder cavity, the waveguide tool 1.2 is removed from the expander-limiter 7, the spent emulsion solution is evacuated.

Through the newly installed cannula 8, the bladder cavity is again filled with a fresh solution of ozonide / NO-containing oil emulsion of the oil-in-water type and its sound is voiced by low-frequency ultrasound energy by external contact in the area of the projection of the bladder on the tissue of the anterior abdominal wall at the frequency of ultrasonic vibrations 44 kHz and the oscillation amplitude of the emitting end of the waveguide tool 25-30 μm through a capillary-porous technological strip 10 (2-3 layers of gauze), impregnated with ozonide / NO-containing em ulia type "oil in water" (figure 3). To do this, lay on the tissue of the anterior abdominal wall in the area of the projection of the bladder a process pad 10 saturated with an ozonide / NO-containing oil-in-water emulsion, install AKU 2.1 with a developed emitting end on it, turn on the ultrasonic generator 2 and carry out contact sounding in within 1 minute. At the same time, the three-way valve 4 is opened, the ozone / NO-containing gas mixture generator 3 is turned on, and (for 1 minute) the ozone / NO-containing oil-in-water ozone / NO-containing gas mixture is bubbled through the cannula 8 ozonide / NO-containing gas, providing high-quality sanitation of cavity tissues and impregnation of ozone / NO-containing medicinal substances in them. At the end of the contact sounding process of the ozonide / NO-containing oil-in-water emulsion and its ozonation by the ozone / NO-containing gas mixture, the spent emulsion is evacuated.

After that, aeration (within 1 minute) of the previously sanitized bladder cavity with ozone / NO-containing gas mixture is carried out (figure 4). To do this, open the three-way valve 4, turn on the generator of ozone / NO-containing gas mixture 3 and supply ozone / NO-containing gas mixture into the bladder cavity through the supply pipe 9 and cannula 8, thereby enhancing the sanogenic effect of the treatment process.

Depending on the nosological form of the disease and the severity of the manifestation of the pathological process, the number of treatment sessions is up to 10. Moreover, the list of procedures performed in one session can be different and is prescribed individually by the attending physician for each patient.

The proposed method for the treatment of bladder diseases of inflammatory etiology, based on the complex physical and physico-chemical effects of low-frequency ultrasound and highly active ozone / NO-containing drugs, can be implemented with conservative and surgical treatment of inflammatory and tumor diseases of the genitourinary system.

Limited clinical testing of the proposed method, conducted on 12 patients (5 men, 7 women) with inflammatory diseases of the bladder and 8 patients (2 men, 6 women) with tumor diseases showed that the method allows to provide:

- high-quality sanitation of the tissues of the bladder cavity by secondary factors of high-amplitude low-frequency ultrasound, which acts directly on the bladder cavity through intermediate ozone / NO-containing medicinal substances, which contributes to the effective cleaning of tissues from pathological contents and impregnation of medicinal substances deep into the tissues, and contact way external ultrasonic exposure to ensure the extraction of pathological contents from tissues due to the initiation of "pr forward "and" reverse "ultrasonic capillary effect;

- forced saturation of the tissues of the bladder cavity with an ozone / NO-containing substance that has anti-inflammatory and carcinogenic effects;

- stimulation of reparative regeneration of bladder tissue in various nosological forms of bladder disease and, above all, inflammatory etiology, leading to a reduction in treatment time and a decrease in the number of relapses of the disease.

Example 1. Patient N., 34 years old. I went to the clinic with complaints of frequent urination, especially when urinating in the area of the bladder. The disease associates with hypothermia. History: chronic bilateral salpingoophoritis, chronic cystitis. Diagnosis: exacerbation of chronic cystitis. Urinalysis: specific gravity - 1010, protein - negative, white blood cells - 10-12 in the field of view, bacteria ++.

The treatment according to the proposed method:

- a dilator-restrictor was inserted into the bladder cavity through the urethra, a cannula was inserted into the bladder cavity, and the cavity was filled with primary ozone / NO-containing physiological saline, the solution was kept in the bladder cavity with the exposure specified in the method description, and then worked out the solution was evacuated from the cavity;

- an ozonide / NO-containing oil emulsion of the oil-in-water type was introduced into the bladder cavity and it was dubbed with low-frequency ultrasound energy at the parameters specified in the description of the method, followed by evacuation of the spent emulsion;

- carried out aeration of the bladder cavity with an ozone / NO-containing gas mixture;

- removed the expander limiter from the urethra.

The patient delayed voluntary urination for 1 hour after the treatment session. The treatment cycle was 5 sessions conducted daily. After three sessions, the patient noted a decrease in the intensity of the cuts in the bladder during urination and an increase in the time interval between the mixes. After 5 sessions, the pains are completely stopped, urination is free, painless, the rhythm of urination is restored. A urinalysis showed no signs of inflammation. With subsequent follow-up of the patient for 6 months, the disease recurrence was not observed.

Example 2. Patient S., 52 years old. Diagnosis: bladder cancer, stage 2, T2 N0 M0. Clinical group 3.

The histological option is a transitional cell highly differentiated cancer. The diagnosis was made on the basis of biopsy studies after resection of the bladder. Operation - resection of the bladder, epicystostomy. In the postoperative period - the clinical picture of cystitis with fever to febrile numbers. Bacterial urine test - Pseudomonas aeruginosa (microbial number - 106 CFU).

In the framework of the traditional treatment of this category of patients, a complex course of additional treatment was carried out according to the proposed method in the process of which:

- the drainage tube was removed from the cystostomy passage and the expander-restrictor was introduced into the bladder cavity through the cystostomy passage, the cannula was inserted into the bladder cavity and the cavity was initially sanitized by filling it with ozone / NO-containing physiological saline, the solution was kept in the bladder cavity with exposure specified in the description of the method, and then the spent solution was evacuated from the cavity;

- an ozonide / NO-containing oil emulsion of the oil-in-water type was introduced into the bladder cavity and it was dubbed with low-frequency ultrasound at the parameters specified in the description of the method, followed by evacuation of the spent emulsion;

- the bladder cavity was again filled with a fresh solution of ozonide / NO-containing oil emulsion of the oil-in-water type and its sounding was performed with low-frequency ultrasound at the parameters specified in the description of the method by external contact in the area of the projection of the bladder onto the tissue of the anterior abdominal wall while bubbling the solution of the emulsion in the cavity, ozone / NO-containing gas mixture, followed by the evacuation of the spent emulsion;

- carried out aeration of the bladder cavity with ozone / NO-containing gas mixture with the exposure specified in the description of the method;

- removed the extender-limiter from the cystostomy passage, restored the drainage of the bladder through the cystostomy.

Further management of the patient was carried out according to standard methods. The treatment cycle according to the proposed method consisted of 10 sessions conducted daily. 3 days after the end of the treatment cycle, the drainage tube was removed, the cystostomy was closed with the restoration of self-urination. The effectiveness of the proposed method for the treatment of diseases of the bladder of inflammatory etiology, used as an adjunct to the main disease, has allowed to reduce the total patient time in hospital to 21 days. The patient was discharged in satisfactory condition. During dynamic observation of the patient over the next 3 months, exacerbation of cystitis was not noted, recurrence of the tumor process was not detected.

Sources of information taken into account:

1. Urology / Textbook for universities. - Ed. 5th, revised / Ed. N.A. Lopatkina. - M .: GEOTAR-honey, 2002 .-- 652 p.

2. Pushkar D.Yu., Korsunskaya I.L., Tevlin K.P. Intravesical iontophoresis of drugs. // Urology. - 2004. - N6. - S.26-30.

Claims (1)

A method of treating diseases of the bladder of inflammatory etiology, which consists in the intravesical administration of a solution of a medicinal substance, exposure to a physical factor and subsequent evacuation of the spent solution, characterized in that the primary rehabilitation of the bladder cavity is carried out by rinsing it with ozone / NO-containing saline, then through 1-3 min spend the evacuation of the spent solution, after which ozonide / NO-containing oil emulsion is injected into the bladder cavity of oil-in-water type and the cavity is voiced through the above intermediate emulsion solution with low-frequency ultrasound energy at an ultrasonic vibration frequency of 26.5 kHz and an oscillation amplitude of the emitting end of the waveguide tool 60-80 μm for 1-2 minutes, and after evacuation of the spent solution emulsions, the bladder cavity is again filled with a fresh solution of ozonide / NO-containing oil-in-oil emulsion of the oil-in-water type and its sounding is performed with low-frequency ultrasound energy at the frequency of ultrasonic vibrations 44 kHz and the oscillation amplitude of the emitting end of the waveguide tool 25-30 μm by external contact in the area of the projection of the bladder on the tissue of the anterior abdominal wall with simultaneous bubbling of the solution of the emulsion ozone / NO-containing gas mixture for 1 min, at the end of contact sound emulsions and its evacuation aerate the bladder cavity with an ozone / NO-containing gas mixture for 1 min.

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