Method of estimating efficiency of chronic prostatitis treatment

FIELD: urology.

SUBSTANCE: one performs ultrasonic echo-dopplerometric investigation of regional blood flow in prostate before and after treatment to determine quantitative parameters. When pulsation index is reduced from 1.39±0.12 before treatment to 1.10±0.09 after treatment and venous blood flow velocity increases, respectively, from 3,91±0.36 to 5,22±0.47, treatment is regarded effective and completed.

EFFECT: increased accuracy of estimation.

1 tbl

 

The present invention relates to the field of medicine, namely, urology, physiotherapy and balneology, and can be used to assess the effectiveness of treatment of chronic prostatitis.

There are various ways to assess the effectiveness of treatment of chronic prostatitis.

So, there is a method of evaluating the effectiveness of treatment of chronic prostatitis by laboratory studies: General blood and urine tests, swabs from the urethra, the study of the secret of the prostate gland (see Tkachuk V.M., Gorbachev A.G., Golanski LI Chronic prostatitis. - L.: Medicine, 1989. - 205; Ilyin I.I. Nongonococcal urethritis in men. - M.: Medicine, 1991. - 241 S.; Tiktinsky O.L., Mikhailichenko CENTURIES Andrology. - SPb.: Media Press, 1999. - 464 S.).

There is a method of diagnosing prostate fluid and whole blood, which by thin-layer chromatography carried out the determination of phosphatization before and after treatment (see Patent No. 2145088, EN).

Closest to the proposed method is a method of evaluating the effectiveness of treatment of chronic prostatitis by ultrasound scanning, which enables to determine the value, the contours, the severity of the capsule and the symmetry of the prostate (see Tiktinsky O.L., S. Kalinin. The prostate is a male disease. SPb., 1994. - 58 S.; Guide to urology. / Ed. by N.A. is Lopatkina - In 3 volumes. - M.: Medicine, 1998. - 1744 S.).

A disadvantage of known methods is the inability to determine the degree of recovery of disturbed microcirculation in the prostate gland.

The technical result of the proposed method is to improve the accuracy of estimation of efficiency of treatment of microcirculatory disorders in the prostate gland in chronic prostatitis.

New to the achievement of the technical result is that when conducting ultrasonic ehodoplerografiya studies identify quantitative and qualitative parameters of regional blood flow before treatment and after treatment.

What is new is that by reducing pulsation index and increased rate of venous blood flow to their norms consider the treatment of chronic prostatitis effective and complete.

While studying the status of regional blood flow in the vessels of the prostate spend the definition of levels of velocity of venous blood flow, peak velocity of blood flow in systole and in diastole and end-diastolic velocity averaged maximum blood flow velocity. Using the values of quantitative indicators of regional blood flow in the vessels of the prostate, expect quality indicators of the nature regionalnog the blood flow of the affected organ, such as pulsation index and the velocity of venous blood flow.

Pulsatile index (PI) is the ratio of the difference between peak systolic and end-diastolic flow velocity to the time-averaged maximum blood flow velocity.

The rate of venous blood (V) characterizes the state of the tone venules, veins and the presence of venous hyperemia of the pelvic organs, including the prostate gland.

Pulsatile index (see Clinical manual of ultrasound diagnostics. Ed. ITV. - M.: Vidar, 1997. - V.3. - 388 C.) most accurately compared with other indices, reflects the state of the peripheral vascular resistance regional arteries and is used to determine the functional changes in the vascular wall regional arteries.

The authors in the research process it was found that in healthy men is the velocity of venous blood flow (V) varies in the range of 4.5-5.5 cm/sec, while chronic prostatitis is its reduction. Pulsatile index (PI) in healthy men reaches 1,10±0.24, and in men suffering from chronic prostatitis, PI increases.

Comparative analysis of the proposed solutions and prototype shows that the inventive method is characterized by the fact that they are carrying out ultrasonic echodopplerography study is the W state regional blood flow of the prostate, determine the quantitative and qualitative parameters and by reducing pulsation index (PI) and increased rate of venous blood (V) to the norm consider the treatment of chronic prostatitis effective and complete. This corresponds to the criterion "novelty".

A new set of features provides a more accurate assessment of treatment effectiveness that meets the criterion of "industrial applicability".

In the analysis of known methods revealed that they lack information about the impact of the distinctive features of the claimed method on the achievement of the technical result, therefore, the invention corresponds to the "inventive step".

The method is as follows.

The study was conducted in a horizontal position of the patient. With the help of the apparatus ALOKA SSD - 2000 Multi View with a sector probe, operating at a frequency of 3.5 MHz, blocks of color and spectral Doppler, performed the determination of the level velocity of venous blood flow, peak systolic and diastolic velocities averaged maximum blood flow velocity. Using the value of quantitative indicators, calculated quality indicator - pulsatile index (PI), i.e. the ratio of the difference between the peak systolic and end diastolic blood flow velocity to the time-averaged maximum the second flow velocity.

Complex treatment of patients with chronic prostatitis includes in addition to traditional methods (antibacterial, anti-inflammatory drugs, hormones, vitamins, massage prostate, mineral sodium chloride baths with a salinity of 30 g/DM3t°36-37°, lasting from 6 to 10 minutes, every other day) application of peloids in the form of applications and rectal swabs of different temperature. All patients (n=122) received rectal swabs (200 grams mud on 1 tampon, duration 20 minutes, every day, for a course of 10 treatments), application sapropelic mud on the type of "briefs" (duration of 20 minutes, a day, a course of 10 treatments). The temperature of the sapropelic mud amounted to t°40-42°C.

The proposed method evaluated the efficacy of treatment in 122 patients with chronic prostatitis aged 18-55 years.

All patients were examined modern generally accepted methods (clinical, laboratory, microbiological, ultrasonic). A single patient complications when conducting research is not marked.

In the study in CP patients in long term after treatment showed positive dynamics of ultrasonic parameters of the prostate and data echodoppler (indexes peripheral vascular resistance is possible), (see table).

Long-term results of treatment were traced in all patients by re-survey a year after the Spa treatment. They were considered bad, if the treatment effect did not exceed three months, and satisfactory to six months. When more prolonged effect of the treatment results were evaluated as good (Recommendations Tniikip Ministry of health, USSR, 1961).

Table.

These actoplusmet in CP patients before and after treatment (M±m)
The indexes of peripheral vascular resistanceThe ball group (n=122)
before the treatmentafter the treatment
The velocity of venous blood flow, cm/sec (V)3,91±0,365,22±0,47*
Pulse (PI)1,39±0,121,10±0,09*
Resistive (RI)0,66±0,060,60±0,05
Note: * - p<0,05.

The proposed method of assessing the efficacy of treatment of chronic prostatitis is illustrated by the following example.

Example.

Patient N., 26 years old, came with complaints of infertility in marriage in the last 3 years, pain in the perineum with irradiation in the sacrum of the region.

During the detailed survey revealed: married 5 years, have one child - 2 years last 3 years, a sexual life regular, without the use of contraceptives, periodic pains in the perineum with irradiation in the sacral area. In somatic status revealed no pathology.

Status localis: external genitals are developed correctly, hair growth on the male type, inguinal lymph nodes up to 1-1,5 cm in diameter, mjagkoellasticheskih consistency, painless. The penis is well developed coronary groove and bridle without features, the urethral sponge is not swollen, not hypermonogenic, discharge from the urethra not, pendulous scrotum, with a strong folding, testicles size 2.5×1.5 cm, photoelasticity consistency, epididymis 0,6×0.6 cm, mjagkoellasticheskih consistency, painless. When finger rectal examination: the tone of the anal sphincter saved, ampulla of the rectum is free, the prostate gland is diffusely enlarged, testovaty consistency, with lots of seals, painful on palpation. The laboratory examination revealed: in smears from the urethra leukocytes 0-1-1 in the field of view of the microscope, in the scraping of the urethra detected Chlamydia trachomatis antigen, while sowing urethral pathogenic microorganisms were not detected in the secret of the prostate gland leukocytes 30-40 in the field of vision, epithelial cells isolated, lecithinated moderately (++). Bacteriological sowing secret of a prostate cancer selected pathogenic microflora - Pseudomonas aeruginosa, total bacterial count 10000.

After 3 days of abstinence from sexual activity is obtained and investigated the ejaculate: volume of 2.5 ml, total sperm count is 175 million, the number of spermatozoa in 1 ml of 70 million, of which have a rectilinear translational motion is 20%, liquefaction time - 45 min, the viscosity after dilution - 4-5 mm, number of cells - 6 million/ml Content of steroid hormones in serum: estradiol 44 ng/l, testosterone and 3.8 ng/ml At ultrasonography of prostate size 34×41×29 mm with fuzzy and rough contours, heterogeneous echostructure and liquid inclusions. When the duplex echodoppler: PI - 1,43; V - 3,82 cm/sec, i.e. the reduction of the inflow of arterial blood and obstruction of the outflow of venous blood.

The diagnosis: a Chronic infectious prostatitis, remission, complicated human fertility. Infertility 11. Asthenozoospermia. Chlamydial urethritis.

Patients received combined treatment with the use of sapropelic mud t°40-42°C (mud rectal tampons, 20 minutes per procedure, daily, for a course of 10 treatments and mineral sodium chloride baths, 10 minutes to 1 procedure through a day, a course of 10 treatments), and started antibacterial therapies into account the sensitivity of the selected microflora to antibiotics and their tropism to the tissues of the prostate, at the same time carried out sanitation of sexual partners. On the 5th day from."the beginning of the course of complex treatment of pain disappeared.

In the study of ejaculate after treatment: the volume of 3.8 ml, total sperm count - 326,8 million, the number of spermatozoa in 1 ml of 86 million, of which have a rectilinear translational movement of more than 55%, time dilution of 30 minutes, the viscosity after dilution of 2-3 mm, the number of leukocyte - 1.5 million/ml bacteriological sowing of the decree of the prostate pathogenic microflora is not sown. At ultrasonography of prostate size 31×38×22 mm, with a clear and smooth contours, homogeneous echostructure and without liquid inclusions. If echodoppler: PI - 1,08; V - 5,44 cm/sec, i.e. the indicators correspond to the healthy person. The concentration levels of steroid hormones also corresponded to normal. 4 months after the end of treatment the wife of the patient's pregnancy ended with the birth of a healthy child. Continued traced for 1.5 years, indicators of semen and prostate fluid is not adversely affected.

Thus, the proposed method of assessing the efficacy of treatment of chronic prostatitis accurately to assess the effectiveness of remedial measures.

The method of evaluating the efficiency cured what I chronic prostatitis by ultrasound, characterized in that conduct ultrasonic echodopplerography study of regional blood flow of the prostate before and after treatment with the determination of quantitative parameters and by reducing pulsation index of 1.39±0.12 to treat up to 1.10±0,09 after treatment and increased velocity of venous blood flow (cm/s) from 3.91±0.36 to treatment before 5,22±0,47 after treatment consider treatment effective and complete.



 

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