Method for treating leukoplakia of urinary bladder

FIELD: medicine.

SUBSTANCE: one should affect the mucosa of urinary bladder due to point coagulation of pathologically altered parts of mucosa. The impact should be fulfilled with electric current, duration per 2 sec/every point at frequency of 440 kHz, the frequency of impulse repletion being about 20-80 kHz, at the power of flash coagulation being of 85-95 W at the rate of argon flow ranged 0.7-1.0 l/min. The suggested innovation enables to control the depth of coagulation of urinary bladder's wall, provides the absence of intra- and post-surgical hemorrhage from the area of argonocoagulation, enables to achieve the absence of coarse cicatricial alterations in urinary bladder's wall in post-surgical period in area of argonocoagulation.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to the field of medicine, urology and may be used for the treatment of leukoplakia of the bladder.

Well-known conservative and operative methods of treatment of leukoplakia of the bladder. Conservative treatment is represented by a combination of bladder instillation solutions of antiseptics, antibiotics, antispasmodics, α-blockers, fiziolechenie [1]. The full course of treatment before the disappearance of symptoms can be several months. When expressed inflammatory changes in the mucosa of the bladder, metaplasia of the epithelium, the use of this technique does not always lead to the desired result.

Closest to the proposed method is transurethral resection of the modified sections of the mucosa of the bladder [2]. However, the known method has a number of disadvantages - hematuria in the postoperative period to several days, for a long period of hospitalization, long-term regeneration of the mucous and General rehabilitation patients.

New technical objective is to reduce the number of complications, shortening the treatment time. To solve the problem in the treatment of leukoplakia of the bladder, is the impact on the mucous membrane of the bladder, carry out spot coagulation pathologically changed the military sections of the mucous electric current with a frequency of 440 kHz, the pulse repetition rate of 20-80 kHz, at a power spark coagulation 85-95 W at a flow rate of argon of 0.7-1.0 l/min, up to 2 seconds per point.

The method is as follows. Under General anesthesia spend four treatment external genital organs of iodopironum. In entering the bladder universal urethrocystoscopy. The bladder fills 5% glucose solution of 150-250 ml In the working channel of the cystoscope set the electrode electrosurgical scalpel "electropolis-350 RF" with a device for supplying inert gas "electropolis WITH 350 RCP" (№ of state registration of the device). Use spark coagulation mode, the end or side of the gas flow. The electrode is led to the site modified the mucosa of the bladder. Mode argon flow with a speed of 0.7-1.0 l/min at spark parameters of coagulation 85-95 W hold point coagulation of the modified sections of the surface of the mucous membrane of the bladder up to 2 seconds per point. When the current frequency 440 kHz, the pulse repetition rate of 20-80 kHz. The total duration of the operation, respectively, is directly dependent on the square of the modified mucous membrane of the bladder. After complete coagulation of the catheter in the bladder is not required.

Clinical example: Patient Was, 24 years old, was admitted in urology the internal medicine Hospital clinics SSMU with complaints of frequent urination, cramps, pulling pain in the lower abdomen. Ill for 7 years. Ill acutely after exposure to cold, when appeared the phenomenon of acute cystitis. Passed out-patient treatment, in which the symptoms of cystitis were stopped. Within 1 month after active treatment, there was no complaint, then came a relapse of the disease. In the subsequent period for cystitis took continuously recurrent nature, while repeatedly carried out courses of outpatient treatment of cystitis do not lead to the expected results. The absence of effects from the conservative therapy was the indication for hospitalization in urological hospital. When receiving a satisfactory condition, palpation was determined moderate pain in nadannoj area. At laboratory examination of changes in the General analysis of blood there. In the General analysis of urine leukocytes 6-8 in sight, no erythrocytes. Cystoscopy: the capacity of the bladder 200 ml transparent Environment. In the area of the bladder neck, triangle, Leto below mioclonica folds defined by whitish on the mucosa of the bladder with clear boundaries, towering over unchanged mucosa, a fixed contact of the cystoscope. Performed a biopsy of the site changed the mucosa of the bladder. On the basis of the survey delivered dia the LCM - leukoplakia of the bladder. The patient received treatment according to the proposed method - ergonomische abnormal areas of mucous electric current with a frequency of 440 kHz, the pulse repetition rate of 20-80 kHz, at a power spark coagulation 85-95 W at a flow rate of argon of 0.7-1.0 l/min, up to 2 seconds per point. Bleeding from the area of coagulation in intra - and postoperative period were observed. The postoperative period without complications. On the 4th day after the operation the patient was discharged in satisfactory condition. In the postoperative period the patient received anti-inflammatory, antibacterial therapy, drugs that improve the microcirculation of the mucosa of the bladder. Control examination performed 2 months after surgery. At cystoscopy bladder mucosa in the area of coagulation pale pink color with no signs of pathological changes. Clinically, signs of dysuria no.

The proposed mode of action is chosen based on the analysis of the results of clinical observations in 20 patients with a diagnosis of leukoplakia of the bladder mucosa. In all patients the diagnosis was based on data cystoscopy, confirmed by the conclusion of the histological examination of the surgical material modified mucous membrane of the bladder, the guiding squamous metaplasia of the epithelium. The clinical picture was dominated by symptoms of dysuria, dragging pain in the lower abdomen, painful urination, which were observed on average 2-5 years. The average age of the patients 28.1 years (from 12 to 53), all patients underwent surgical treatment according to the proposed method - volume coagulation area of leukoplakia argon electrode with a course of conservative therapy in the postoperative period. Patients in 1.5-3 months after the treatment was carried out control cystoscopy, analysis of complaints. As a result, in the studied group at follow-up 13 patients did not complain of anything on the control cystoscopy bladder mucosa in the area of organomegaly pale pink with no signs of pathological changes. In 7 patients showed signs of dysuria. When the control cystoscopy was determined areas of acute inflammation of the mucosa of the bladder-type edema and hyperemia of the mucosa of the bladder, a moderate accumulation of uric salts. After the appointment uroseptics therapy in combination with bladder instillation of antiseptic solutions within 1 month was observed clinical recovery. In one case, within 10 days after the surgical treatment, the patient noted makrogematuriya within 2 days. The follow-up period was 6 months.

Justification mode is Proposed in this method, the operation mode (the influence of currents of high frequency 440 kHz in the stream of argon, at the speed of 0,7-1,0 l/min when the spark parameters of coagulation 85-95 W; point coagulation plots altered mucosal surface of the bladder for up to 2 seconds for each point selected on the basis of clinical trials, confirmed by studies of experimental sections on the cadaver the coagulated material of the bladder wall. When the magnitude of gazobetona increases the number of gas bubbles during coagulation, which complicates the visualization of the area of metaplasia. When the reduction mode gazobetona sufficient level necessary depth of coagulation area of mucous membrane to achieve the impossible. With the increase of spark parameters of coagulation is the deepening of the zone of coagulation, which can lead to thermal injury and deterioration of the mucosal recovery in the postoperative period. When reducing the size of the coagulation mode to achieve the desired depth of coagulation is impossible.

Validated methods: visual inspection after 2 months: to evaluate the clinical complaints, control cystoscopy, histological examination of the mucosa at the site of coagulation.

The advantage of the proposed method

Controlled depth of coagulation walls of the bladder, which makes it possible to avoid perforation.

- Lack of intra - and postoperative cu is bleeding skills from the field of organomegaly.

- The absence of severe scarring of the bladder wall in the postoperative period in the field of organomegaly.

Short rehabilitation period.

- Reduction of terms of stay of the patient in hospital.

- High efficiency of the method (the complete removal of a section of leukoplakia).

Sources of information:

1. Sviluppati et al. Cystitis in women./Edited beznoshchenko G.B. - M: Medical book, Nizhny Novgorod: publishing house of the ngma, 2004.

2. Ahisamach, You, Avisync and other Treatment-resistant dysuria in women. Urology - 2003; 1:46-49.

Treatment of leukoplakia of the bladder through the effect on the mucous membrane of the bladder, wherein the hold point coagulation abnormal areas of mucous electric current up to 2 s at each point with a frequency of 440 kHz, the pulse repetition rate of 20-80 kHz, at a power spark coagulation 85-95 W, at a flow rate of argon of 0.7-1.0 l/min



 

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