The method of complex treatment of chronic urethritis, urogenital infections caused

 

(57) Abstract:

The invention relates to urology and is intended to be a comprehensive treatment of chronic urethritis, urogenital infections caused. The treatment is carried out in 2 stages, in the form of pulse therapy with 3-day intervals. In the first year appoint the immunomodulator lacapere in the form of suppositories for 40 thousand UNITS, daily, at the rate of 10 candles. On the background of immune treatment by Unidocs and red laser radiation semiconductor laser with an efficiency of 40 - 60%, 30 mW. In the second year - ruled and transurethral electrolatino stimulation. The method allows to increase the effectiveness of the treatment.

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

Chronic urethritis, urogenital infections caused is one of the complex medical and social problems, due to the prevalence and difficulties of treatment. Urogenital infections new generation (chlamydia, mycoplasmosis, ureaplasmosis and others) often occur in the form of microbial associations, are prone to long-term persistence and chronic course, which is accompanied by inflammation of the mucous membrane of the urethra and the urethra is e gland due to violation of local blood supply, and also due to infiltrative sclerotic changes of individual sections of the urethra.

The main method of treatment of chronic urethritis, urogenital infections caused is the combined use of antibiotics (macrolides, drugs doxycycline) and different methods of local impacts (endourethral introduction of medicines and physical therapies mucous membrane of the urethra) (Maydanyuk C. F. Stepanenko, C. I. , Krasun L. E. Some questions of diagnostics and treatment negoianu urethritis in men. Pathogenesis and treatment of common chronic dermatosis and venereal diseases, 1983, Kiev, S. 121-124). As a local therapy known application in the form of instillation 1-2% solution of protargol and silver nitrate solution (Radi O. I. Etiology, clinic and treatment negoianu urethritis. Nursing, 1964, No. 10, S. 141). There are publications about the local application katafera - immobilized enzyme of microbial origin (Manikin Century A. the Treatment of mixed infections by azithromycin, tridecanol and katterman. Abstract. Diss. K. M. N., M., 1997), Backplane - biologically active complex (Kartavtsev R. the deeper problems of scientific and practical dermatology venereology, 1994, M., S. 13-14), UV-irradiated autologous blood (Suvorov A. P., Orkin C. F., Kaplanov C. D. Treatment of residual urethritis by instillation autologous blood. Journal of dermatology and venereology, 1991, No. 12, S. 85-86). However, the local action of drugs briefly and incapable of deep penetration and deposition in tissues. The use of some chemicals can cause chemical urethritis with inflammatory infiltration of the submucosal layer, thickening and metaplasia of columnar epithelium, and subsequently to the formation of strictures of the urethra, which is confirmed by endoscopic studies.

Of the physical methods of treatment of chronic urethritis and urethral strictures are used endourethral electrophoresis of silver ions, antibiotics, and others, combined with the use of electrophoresis and inductothermy, pulse current, low-frequency and high-frequency ultrasound, magnetotherapy and magnetophoresis (Stepanenko Century. And., Kolyadenko such as experience in the treatment of chronic urethritis in men by iontophoresis and inductothermy. Journal of dermatology and venereology, 1990, No. 6, S. 55-59).

Similar to the inventive method, the authors propose a method for the treatment of residual urethritis and its complications discontenting complications of low-intensity laser radiation. Journal of dermatology and venereology, 1990, No. 11, S. 36-39). Includes endourethral use of red laser radiation apparatus LH-75 output power 9-12 mW in combination with antibacterial drugs. However, this treatment method has certain disadvantages: only the red laser light with a low power output, not used immunomodulators and a combination of several physical factors.

According to the authors, the prototype of the proposed method is a method of treatment of low-intensity laser radiation lesions of the urethra (Miroshnikov B. I., L. Reznikov L, Yakushev Century. And. Laser postinflammatory strictures of the urethra. Journal of dermatology and venereology, 1991, No. 1, S. 63-66). Used endourethral red laser (helium-neon laser) on the machine LH-75 with an output of 30 mW. In the course of 12-15 procedures, each combined with bujirovanie. Despite the fact that a large output laser power (30 mW) efficiency (ratio of power radiated energy to the power absorbed) helium-neon laser 1-2%. In addition, this method is devoid of a comprehensive approach to treatment is used only red Torah may offer their own way of treatment of chronic urethritis, due to urogenital infections in two rounds of pulse therapy with an interval of 3 days: 1) the immunomodulator lacapere, unidox, endourethral red laser radiation apparatus AZOR-2K"; 2) rule and transurethral electrolyzerna stimulation apparatus "JARI", which was previously used for the treatment of chronic chlamydial prostatitis (Tiktinsky O. L., Kalinin S. N. , Novikova L. I. and other Electrolyzerna therapy device "JARI" in patients with chronic chlamydial prostatitis. Urology and Nephrology, 1997, N 4, S. 25-29).

Comprehensive treatment began with immune drug lacapere in the form of suppositories for 40 thousand UNITS, daily, at the rate of 10 candles. On the background of immune correction was prescribed the antibiotic unidox 0.1 g 2 times a day after meals with the exception of dairy food, at the rate of 2.0, After three days of interval - ruled 0.15 grams 2 times a day after meals, at the rate of 3.0 g

For local therapy was used endourethral combined and sequential red laser exposure apparatus AZOR-2K" and transurethral electrolatino stimulation apparatus "YAR". The first course of treatment from the first day of antibiotic therapy was performed on urethral method through a special rate "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 V) 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. Following the chosen methodology, carried out the procedure within 5-10 minutes.

The second course was carried out on the apparatus AALTO-01 "JARI" (decision from 04.10.96, TU 9444-001-16997774-94, Certificate ROSS EN THEM 02 V), starting from the second course of antibiotic therapy. The exposure duration from 8 to 12 minutes, every day, for a course of 10 treatments. Installed the plate electrode in lumbosacral position, 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 electrode-catheter with fiber for supplying energy helium-neon laser. A sterile catheter was introduced to the webbed Department of the urethra, pre-processed steel. The emitter of infrared laser radiation recorded on the pubis, in the projection of the prostate. The frequency of stimulation pulses was set in the range of 0.5-50 Hz, the frequency of the IR laser radiation in three frequency ranges 3-30 Hz 30-300 Hz 300 to 3000 Hz, changing during the procedure, setting the current of the electrical stimulation is adjusted depending on the patient's feelings. Radiation is a helium-neon laser with a wavelength of 0.63 µm is generated in a continuous mode, with a maximum output power of 5 mW.

Under our supervision was 214 men aged from 24 to 63 years, with disease duration from 1 to 10 years. Clinical manifestations characterized by significant diversity: urethral complaints, pain, disorders of sexual function and neurotic disorders.

Urethrocystoscopy on flexible fiberscope "URF-P2" company "OLYMPUS" has allowed you to diagnose various lesions of the urethra and bladder: atonic cystitis (14,9%), colliculitis (78,9%), fibrous and granulation urethritis (94,3%), urethral adenity (85,9%), polyps and warts urethra (15,8%).

Microbiological examination methods of DFA and PCR revealed that 57.9 per cent of patients with chlamydia, 33,6% - mycoplasmosis, 19.1 per cent ureaplasmosis, gonorrhea at 3.2 per cent,from research established immunosuppression, affecting interferonogenez, inhibition of T-cell immunity and early activation of lymphocytes.

After treatment observation has established a significant decrease and complete disappearance of the "urethral" complaints in 92.9% of patients. Etiological cure bacterial infections observed in 96.7% of patients.

Re urethrocystoscopy established cure urethral edenite 91.3% of patients, urethritis - 96,0%, colliculitis - 82,8%, warts - 38,2% of patients.

Remote observations in the period from 1 year to 2.5 years have established a lasting cure urethritis and reducing the number of relapses of chronic prostatitis.

Clinical and etiological cure correlated with the restoration of immunological parameters.

Thus, the method has a qualitatively new approach and high efficiency in the treatment of chronic urethritis and its complications, accompanied by recovery from a bacterial infection and correction of immunological parameters.

Example: a Patient Century, 27 years old, (outpatient map N 248/99), he complained of pain during urination, scanty discharge from the urethra, a feeling of heaviness in the perineum, Sniv the urethra and abundant purulent discharge. To the doctor did not address, was treated independently - made a few bicillin injections. Selection stopped. However, in 1-1,5 months began to disturb pains in the urethra during urination and pain in the perineum. Repeatedly receiving treatment with long courses of antibiotics. Relapses occurred 5-6 times a year. The last 2 years of constant and only sexual partner.

External genitals are developed correctly. The urethral sponge is slightly hypermonogenic. The scrotal organs without pathology. When examination of scrapings from the urethra - leukocytes 14-16 p/al, PCR methods and MIF detected chlamydia and Ureaplasma. When finger transrectal study, the prostate gland is diffusely enlarged, Central sulcus smooth, the surface is smooth, the consistency of "testovaty", palpation is painful. Secret of the prostate gland leukocytes in 30-40 p/SP, lecithin grain 8-10, violation of the phenomenon of crystallization of the I century

The transrectal us prostate cancer: heterogeneity echoes due to alternating Hypo - and hyperechoic areas. Extension periprostatic veins.

Urethrocystoscopy on the fiberscope company "OLYMPUS". Bladder: a vascular drawing is not changed, trabeculae is t; the posterior urethra is the presence of transient infiltration, seed tubercle increased, closes the lumen of the urethra, hyperemia and deformed; the anterior urethra is the Central figure in there, vascular pattern is not expressed, mucous balsavage color, inflamed glands of Littre and crypts of Morgagni, in their mouths purulent tube.

The immunological: CD4= 0,21109/l; IRI= 1,1; SD20= 0,6109/l; SD3= 1,06109/l; phosphoinositides in SD3and SD20- 91,4 μm phosphorus/mmol/l, and 80.3 μm phosphorus/mmol/l, respectively, interferon - and - 80 units and 32 units, respectively.

The Diagnosis Of Chlamydia. Ureaplasmosis. Chronic total urethritis (colliculi, solid infiltration, littleit, morganii). Chronic lung prostate.

Treatment: 1 round - lacapere (rectal suppositories, the rate of N 10), unidox (2,0 course); endourethral use of red laser radiation apparatus AZOR-2K daily (at the rate of 10 treatments). After a 3-day interval - round II: rule (1.5 year), day after transurethral electrolyzerna stimulation apparatus "JARI" (a course of 10 treatments).

After the first 2 sessions significantly decreased pain in the urethra. Full precedental reducing the size of the prostate gland, improving its tone, reducing the number of cells in the gland secretion and the scrapings from the urethra. By the end of second year (30-day treatment), the patient noted a significant increase in General vitality, normalization erections and increased libido. When transrectal study - gland is not enlarged, slabosolenaja, the Central groove is defined consistency photoelasticity. Analysis gland secretion - leukocytes 2-3 in eyeshot, lecithin grain in large numbers, the phenomenon of crystallization saved.

The prostate transrectal us: some heterogeneity echoes, exonerative education is not rendered.

When the control urethrocystoscopy a decrease in the intensity of inflammatory changes in the field of seed tubercle, the Central figure is saved, appeared radialnet vascular pattern in the urethra, glands of Littre and crypts of Morgagni not inflamed.

The immunological after treatment: SD4= 0,5109/l; IRI = 1,5; SD20= 0,280109/l; SD3= 1,2106/l; phosphoinositides in SD3and SD20is 71.5 μm phosphorus/mmol/l and 58.7 ám phosphorus/mmol/l, respectively, interferons and 160 units and 64 units, respectively.

Control the priority clamidiosis and a ureaplasmosis, about what the treatment). In the follow-up period (8 months) recurrence of the disease the patient has not occurred.

The method of complex treatment of chronic urethritis due to urogenital infections, including the prescription of antibiotics, endourethral use of red laser radiation and transurethral electrolatino stimulation, characterized in that the treatment is carried out in 2 stages, in the form of pulse therapy with 3-day interruption: in the first year appoint the immunomodulator lacapere in the form of suppositories for 40 thousand UNITS, daily, at the rate of 10 candles, on the background of immune treatment by Unidocs and red laser radiation semiconductor laser with an efficiency of 40 - 60%, 30 mW; in the second year - ruled and transurethral electrolatino stimulation.

 

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