A method of treating neurogenic bladder dysfunction

 

(57) Abstract:

The invention relates to medicine, in particular to urology, and can be used for the treatment of neurogenic bladder dysfunction in children and adults. I propose to enter alpha-1-blocker such as doxazosin. The method provides effective treatment, including urinary incontinence in children with myelodysplasia. 3 C.p. f-crystals.

Treatment of neurogenic bladder dysfunction is an important problem in children and adults. Urinary incontinence in children is a result not only of bladder dysfunction, and severe congenital malformations of the spinal cord. Mechanisms for the development of neurogenic dysfunction in adults in the prostatectomy, "the aging of the bladder and other processes studied enough, and therefore adequate treatment to choose is difficult. The experience of previous researchers showed that the effects of nootropics and cholinolytics on the neurogenic bladder has a short-term effect and does not solve the problem of selection of adequate treatment.

Research results in various fields of medicine proved that the condition of blood circulation of any authority and a violation of his functions vsako is a spasm of a coronary artery. According to the results of recent studies major role in the development of atherosclerosis and coronary heart disease divert the formation of oxidized lipoproteins that increase the ability of blood vessels to contract and reduce the metabolism of the cells of the vascular wall. Mild vascular spasm, active oxygen to the tissues, improve circulation, and thereby to restore the impaired function of the heart muscle (Kurashvili C. A., 1999).

In the same clinical situation of the various organs and tissues varies supplied with oxygen and suffer from its lack, so we can talk not about the fetal body, and hypoxia body. Including the bladder (Ryabov, A., 1988).

The question of the nature of the supply of individual organs and tissues with oxygen and adequate methods of evaluation is extremely difficult, since the process depends on many factors - gas exchange in the lungs, the condition of the cardiovascular system, the total area of open capillaries, the blood flow colorability enzymes. Today, universal methods of research of a level of hypoxia in the clinic. Therefore, very few studies on the supply of detrusor oxygen in oral the (1985) found in experiments on rabbits, that hypoxia can lead to Hyper-or hyporeflexia detrusor. Moreover, the polar variants experimental models of bladder dysfunction corresponds to a similar trend of decrease of glycogen, ATP, increase in oxidized and reduced enzyme.

Later, Chen et al (1996) when creating ischemia of the bladder in the experiment observed the development of changes in detrusor observed when infravesical obstruction and acute urinary retention.

According to Soypak Century (1996) when creating ischemia of the bladder in the experiment observed the development of changes in detrusor observed when infravesical obstruction and acute urinary retention.

Previously (Guseva N. B. 2000) method rheocystocervicography (RCCG) we found that in children with myelodysplasia (MD) is expressed by a circulatory disorder of the bladder. These observations are the basis for application of vasoactive funds: low-intensity laser therapy, hyperbaric oxygen therapy and other Significant improvement in the functions of the NRM (neurogenic bladder) in these patients occurs when treatment drug PIKAMILON. This nootropic drug in the circulation, by accumulation of ATP reduces the level of hypoxia. But, we assume that the fastest means - alpha-blockers, because the alpha-adrenergic receptors are located not only in the sphincter apparatus of the bladder and the urethra, but also in the vascular wall. The state of the receptor activity of this SYNOPTIC communication, interaction with norepinephrine accompanied by increased tone of specified anatomical structures (wad S. A. Downie J. W., 1977).

Develop a method of treatment is to restore the function of the neurogenic bladder in children with myelodysplasia by affecting the circulation of the bladder.

DOXAZOSIN(XATRAL), alpha 1-adrenergic. Khinazolinov derived, 1-4-piperazine nanomeasurement. Has hypotensive, vasodilator, anti-sclerotic effect. Selectively blocks postsynaptic alpha 1-adrenergic receptors, inhibits the synthesis of collagen in the vascular wall, reduces the tonus of the smooth muscle cells of the prostate, bladder neck and urethra.

Under our observation were 20 days with myelodysplasia and urinary incontinence, 5-15 years. In 13 children congenital spinal herniated lumbosacral about is the train in the neonatal period and 6 patients with latent (tissue) form of myelodysplasia, spastic pelvic floor. In 4 children in the urge to urinate was saved. 5 - reduced and replaced by an equivalent. 11 children the urge to urinate was absent. Independently drained the bladder 3rd of patients. 7 patients had drained the bladder independently, and display of residual urine after each addition. 10 patients were on an individual mode of intermittent catheterization. According to urodynamic examination only in 3 patients with neurogenic dysfunction was caused by dysfunction of the detrusor, the remaining 17 children incontinence was combined resulted in the defeat of the detrusor and sphincter apparatus.

Method rheocystocervicography (RCCG) revealed that 10 patients systolic amplitude of blood in a pool of blood vessels of the bladder neck was 0.01 Ohms when emptied bladder and 0.03 Ohms when filling the bladder to medium volume (average standard rates 0,115 Ohms and 0.09 Ohms, respectively). Thus these children the amplitude of the blood was significantly reduced, indicating that violations of the vascular bed type angiotelectasia. Similar disturbances of microcirculation were detected in these group.

The remaining ten children systolic amplitude when emptied bladder was 0.3 Ohms, and when filled to the average volume was significantly increased to 0.6 Ohms. These data suggested violation of organ blood flow by spastic type. By biomicroscopy vessels revealed spastic disorders of microcirculation 2-3 degrees.

Execution method: children were prescribed a drug xatral with written parental consent. Children up to 10 years 0.0005, and over 10 years of 0.001 in the morning, lying, under the control of arterial pressure, once.

The rhythm control urination or catheterization bladder urodynamic studies, RCCG, biomicroscopy of the vessels of the conjunctiva was performed after 7 days of medication. In 7 children with angiospasm and 5 children with angiotelectasia noted improvement in endoscopy and blood flow, other indicators remained unchanged. Given that no adverse events noted, all children continued treatment corduroy in the same dosages up to 30 days.

The survey compared with a 1-month course of xatral showed that clinically bladder function improved in all children. Effective volume sociopath on urination and episodes of self-urination. According to RCCG in patients with angiotelectasia the amplitude of the blood when emptied and filled bladder is increased to 0.05 Ohms. Adaptation of the detrusor according to endoscopy has improved from 30% to 45-50%. Sphincter activity increased 2 times. The conjunctival biomicroscopy revealed improvement of microcirculation by 1 degree: from 2-3 to 1-2 tbsp. tbsp. patients with angiospastic violations occurred similar positive changes. According to RCCG the amplitude of the blood when emptied and filled bladder decreased to 0.2 - 0.25 Ohms. Adaptation of the detrusor has improved from 15% to 35-40%. Sphincter activity improved in 2-3 times. By biomicroscopy of the conjunctiva microcirculation happened to 1-2 tbsp.

Clinical examples

1. Girl, 7 years old, was operated on for congenital spinal hernia repair in the neonatal period. Self urination no, no urge, is on intermittent catheterization of the urinary bladder in 2 hours. Portion of urine 150-200 ml.

According to the survey somatic innervation of the pelvic floor broken. The pressure in the bladder 6-10 cm H2Oh, adaptation detrusor 63%, areflexia detrusor. According to the pros who itude blood when empty and full bladder was 0.03 Ohm. The conjunctival biomicroscopy revealed a violation of microcirculation 2-3 degrees by type of angiotelectasia. After 7 days of reception of xatral the act of urination has not changed, but according to RCCG the amplitude of the blood supply is increased to 0.05 Ohms. After taking the drug for 1 month, the girl began to urinate in small streams in the morning after the night portion of 30-40 ml residual urine 100-120 ml According to RCCG the amplitude of the blood with bladder filling was increased to 0.07 Ohms, and when emptied to 0.08 Ohms. Adaptation of the detrusor increased to 75%, and sphincter resistance decreased to 8343 unit of the State of microcirculation improved to angiotelectasia 1-2 degrees.

2. The boy is 8 years, operated in the neonatal period for congenital spinal hernia. Independent no urination, urine is in a vertical position constantly leaking drop by drop, lying accumulates 30-50 ml Urge not.

Innervation of the pelvic floor broken. According to the survey, the pressure in the bladder 53 cm H2Oh, adaptation detrusor 10%. Sphincter resistance when the length of the functional parts of 3.9 cm 456 units of the amplitude of the blood when empty and full bladder 0,that the boy appeared dry periods of 5-10 min, portions of 10 ml of Adaptation detrusor improved to 34%, intravesical pressure decreased to 32 cm H2O. the amplitude of the blood during the filling and emptying of the bladder decreased to 0.20 Ohms. Sphincter resistance increased to 1253 unit At the end of the monthly rate of drug the child urinated on 20-30 ml once a day, 10-20 ml after each portion of residual urine was compiled by catheter became dry in a vertical position up to 30 minutes Adaptation of the bladder has improved to 50%, sphincter resistance increased to 2174 units According to the biomicroscopy of the vessels of the conjunctiva microcirculation status improved to violations of 1-2 degrees by type of angiospasm. The amplitude of the blood decreased with bladder filling to 0.17 Ohms, and when emptied: to 0.18 Ohms.

Thus, we can assume that doxazosine have some additional effect on the circulation of the bladder, which has been a significant improvement in the function of the bladder.

1. A method of treating neurogenic bladder dysfunction, characterized in that a therapy with alpha-blockers.

2. The method according to p. 1, characterized in that conduct nerpio doxazosin is P CLASS="ptx2">

4. The method according to PP. 1-3, characterized in that the dosage of doxazosin in children is under the age of 10 years 0,0005 once a day, and in children older than 10 years 0,001 once a day.

 

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