The method of complex treatment endourethral warts

 

(57) Abstract:

The invention relates to urology and is intended for the integrated treatment endourethral warts. Applied human leukocyte interferon, which is injected intramuscularly in a dose of 500 thousand IU/ml after day, in the course of 15 injections in combination with endourethral therapeutic red laser power of 30 mW and a duration of 10 minutes Method can improve the effectiveness of the treatment.

The invention relates to medicine, namely to venereology and urology.

Endourethral warts are one of the complex medical and social problems due to the wide availability and difficulty of treatment. Despite the fact that most often genital warts are located on the vulva, in recent years there has been a high percentage (>20%) endourethral localization. The main methods of treatment: destructive, cytotoxic, anti-viral, immunological, not produce the desired therapeutic effect, many of them difficult in technical execution and are accompanied by a considerable number of complications.

Destructive methods include: electrocoagulation, lutherkirche the rapid effect in 80-95% of patients (Belyaeva So on, Antoniev A. A. Modern aspects of treatment of genital warts. Journal of dermatology and venereology, 1989, No. 7, S. 58), but is accompanied by complications such as education nonhealing defects and scars on the place of removal, followed by the formation of stricture of the urethra. Cryotherapy using liquid nitrogen and carbon dioxide acts by quick freeze intra - and extracellular fluid; defrosting is accompanied by destruction and lysis of cells. The effect can be achieved in 69-100% of patients (Belov, L. C. On the treatment of genital warts. Journal of dermatology and venereology, 1983, No. 5, S. 60-62). The disadvantages and complications are marked local inflammation with severe pain and swelling, as well as relapse after treatment in 10-15% of patients. Heidestrasse includes external use vysokokontsentrirovannykh chemicals (trichloroacetic acid, salicylic-resorcinol the collodion, solkoderm and others), which has a destructive action (Gusakov N. And., Korostylev A. F. experience in the treatment of warts by perhydrol. Journal of dermatology and venereology, 1980, No. 10, S. 36-37). These methods are impossible to apply in the urethra, so as to cause the destruction of the mucosa and can provoditsya violation of viral DNA synthesis (5-fluorouracil, prospidin, podophyllum) (Egorov N. A., Shcherbakov, I. B. About therapy genital warts. Journal of dermatology and venereology, 1980, No. 10, S. 57-59). Complications are local inflammatory processes with weeping, ulceration, stricture of the urethra; the effect occurs in long periods from 10 to 30 days.

Antivirals are most often used topically in the form of ointments (oksolina, cebrian, gossypol and others) (Zhukov N. A. Treatment genital warts in women. Journal of dermatology and venereology, 1983, No. 9, S. 65-67). Their use is often accompanied by local complications, such as contact dermatitis and low rate of recovery.

Similar to the inventive method, the authors propose a method of treating endourethral warts with the use of preparations of human leukocyte interferon (CLI) and lacenterra (Dubno centuries, Kuznetsov, B. N., Belyaev D. L., Tarkhanov Century, the Drugs interferon in treatment of genital condylomatosis. Actual problems of modern Virology, 1995, Ekaterinburg, S. 88-93). CLI was administered topically to the lesions 500 thousand IU/ml daily, at the rate of 6 injections. Lacapere used in the form of intramuscular injections of 10 thousand IU every other day, on kurnia endourethral warts is not high and there is a large number of relapses.

According to the authors, the prototype of the proposed method is a combined method of treatment endourethral warts: preparations of human leukocyte interferon (CLI), lacenterra and removing endourethral condylomas high-energy (surgical) laser apparatus Scalpel-1" (Dubno centuries , Kuznetsov, B. N., Belyaev D. L. Comparative effectiveness of various methods of treatment of human papillomavirus infection. Collection of scientific works: current problems in dermatology and venereology, 2000, M., S. 45-46). CLI was administered topically to the lesions on 100 thousand IU/ml daily, in the course of 3 injections. Lacapere used in the form of intramuscular injection of 10 thousand IU every other day, at the rate of 20 injections. A week after local injection of CLI in the lesion was performed resection of the endourethral condylomas high-energy laser (continuous output power greater than 4 W) on the device "Scalpel-1". The effectiveness of lasertechnologie with local and systemic application of drugs interferon 60-92,5%, but is accompanied by a prolonged nezazelene RAS (up to 3-4 weeks), and possible secondary infection and the formation of significant scarring and strictures of the urethra.

The authors suggest costcompetitive (therapeutic) red laser AZOR-2K" with output power of 30 mW and intramuscular injection of human leukocyte interferon 500 thousand IU/ml at the rate of 15 injections.

Treatment was started with intramuscular injection of human leukocyte interferon 500 thousand IU/ml after day, in the course of 15 injections. On the background of immune conducted endourethral low (therapeutic) red laser effect through a special nozzle N 10 through the emitter To 30 (with output power of 30 mW and an efficiency of 40-60%) apparatus AZOR-2K" (decision of the Committee on new medical technology health Ministry from 08.11.93, Protocol No. 9, THE 9444-001-34611264-95, Certificate ROSS RU TH 46 IN 1045) daily for 10 days. The procedure was carried out as follows: the head of the penis was freed from the flesh and holding the fingers of the left hand, right hand gently and slowly injected transurethrally nozzle N 10, enshrined in the emitter 30 and processed pre-sterile sea buckthorn oil. Next I set the frequency in the CW mode, the wavelength of 0.65 μm and an output power of 30 mW. The duration is 10 minutes.

Under our supervision were 48 men and women aged 22 to 44 years, with disease duration from 1 to 10 years. Patients complained of pains in the urethra, itching, designational all patients endourethral HPV in the hanging part of the urethra.

Microbiological examination methods of PCR were carried out to decide the type of virus, identified HPV types 6, 11.

Immunological studies have established the immunosuppression affecting interferonogenez, inhibition of T-cell immunity and early activation of lymphocytes.

After treatment re-urethroscopy established cure endourethral warts at 93,75% of patients.

Remote observations in the period from 1 year to 2.5 years have confirmed a strong recovery and no recurrence endourethral warts.

The clinical cure rate was correlated with the restoration of immunological parameters.

Thus, the method has a qualitatively new approach and high efficiency in complex therapy of endourethral warts and correction of immunological parameters, leads to a high rate of recovery, characterized by the absence of relapses and complications of therapy.

Example 1: the Patient T., aged 34 had complained of constant itching and burning in the urethra, increased urination, scanty discharge from the urethra. Considers himself ill for 4 years, when for the first time in the area of the frenulum noticed about sizes and formations turned to the doctor. Was held ureteroscopy and exhibited clinical diagnosis of genital warts glans penis and urethra (anterior third of the hanging part); conducted lasertechnologie formations. After 3 months came relapse. In the past 4 years have been conducted on laserodestruction, but education arose again. Last year the patient was bothered by itching and burning in the urethra, increasing urination and split stream of urine. External genitals are developed correctly. The urethral sponge is slightly hypermonogenic. On the glans penis of education are not defined. When examination of scrapings from the urethra - the leukocytes in 20-25 p/SP., pl. epithelium-3-6 in the p/SP. Methods DFA and PCR other pathogens or infections are not detected.

Studies of immunity: CD4 - 231 u/ml, CD8 - 324 IU/ml, IgM - 0,72 g/l, IgG - 0,76 g/l, IgA - 0,43 g/l, IRL- - 112 ME, Earl-- 36 ME.

Urethrocystoscopy on the fiberscope company "Olympus". Bladder: a vascular drawing is not changed, trabeculoplasty expressed, the mouth of the ureter slit, not deformed, education and defects on the mucous membrane absent; posterior urethra - the presence of transient infiltration, seed tubercle hyperemia and enlarged; anterior - Central figure and crypts of Morgagni. In the front third of the suspension Department found endourethral genital warts protruding into the lumen of the urethra in the form of 2 sosochkovykh formations red-pink color, soft texture, up to 2-3 mm in diameter, sitting on a thin and short stalk.

Diagnosis: MBC: endourethral genital warts front third of the hanging part of the urethra. Chronic urethritis (colliculi, solid infiltration, littleit, morganii).

The treatment Started with intramuscular injection of human leukocyte interferon (CLI) 500 thousand IU/ml after day, in the course of 15 injections. On the background of immune conducted endourethral low (therapeutic) red laser (output power of 30 mW and an efficiency of 40-60%) apparatus AZOR-2K daily, in the course of 10 treatments.

After the first 2 sessions on the device significantly decreased pain in the urethra. Complete cessation of burning reached to 5 the procedure.

The patient showed restoration of indices of cellular and humoral immunity, interferonogenesis.

When the control urethrocystoscopy normalization of the shape and color of seed tubercle, the Central figure is saved is m, and other entities in the urethra - no.

In the follow-up period (2 years) recurrence of the disease the patient was not.

The method of treatment endourethral of warts, including the use of leukocyte interferon and laser radiation, characterized in that human leukocyte interferon is administered intramuscularly in a dose of 500 thousand IU/ml after day, in the course of 15 injections in combination with endourethral therapeutic red laser power of 30 mW and a duration of 10 minutes

 

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FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.

SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.

EFFECT: higher efficiency of therapy.

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