RU2564753C1 - Method of assisting urine passage in ureter - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes an influence with electric current through electrodes. One electrode is placed in the area of the pubic bone, with the remaining ones being placed paravertebrally on the external edge of the spine-straightening muscle, in the area between XII rib and the sacral part. Then, a signal with the frequency in the interval of 5-32 kHz, amplitude not higher than 3 W, current power not higher than 20 mA, formed into a 0.1-0.2 msec long pulse, is sent to the closest to XII ribs paravertebrally placed electrodes. The pulses are formed in packages with the duration of 0.5-1 sec, the time between the pulses in the packages is 0.01-0.8 sec. The influence is performed successively on each of the paravertebrally placed electrodes towards the sacral part with 5 sec delay. Successive supply of the pulse packages on the paravertebrally placed electrodes from XII rib to the sacral part is repeated after 5 sec. The influence is realised for 5-10 minutes, 1 time per day, for 5-20 days.

EFFECT: method increases the treatment efficiency due to the recovery of the upper urinary tract tone.

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Description

The invention relates to the field of medicine and biophysics, can be used in pediatrics: nephrology, urology.

There is a method of restoring the urodynamics of the upper urinary tract by stimulating the ureter with a pulsed current using a catheter electrode, characterized in that the stimulation is carried out by sequentially transmitting a pulse to the contact surfaces of the multi-contact catheter electrode that are isolated from each other and located along the ureter, which are laid and fixed directly along the ureter during surgery (see patent for the invention of the Russian Federation No. 2263519, IPC A61N1 / 32).

However, this method is invasive, which limits its use in widespread practice, especially in children. This method can only be used in children who need surgery, which does not allow it to be used in children who do not have gross defects, but who also have a violation of the urodynamics of the upper urinary tract. When carrying out this method, direct damage to the walls of the urinary tract, as well as the attachment or strengthening of the inflammatory process, which also limits the application of this method, is possible. This technique cannot be applied in the acute period of pyelonephritis. In addition, this technique can only be applied in surgical hospitals.

A known method of rehabilitation of children with chronic pyelonephritis by kinesitherapy, which consists in carrying out a complex of active gymnastic exercises, including general developmental physical exercises for all muscle groups (see patent for the invention of the Russian Federation No. 2185803, IPC A61H1 / 00, A63B 23/18, A63B 23/02 )

The disadvantage of this method is the impossibility of its use for young children. Another disadvantage of this method is the lack of local effects on the upper urinary tract and the inability to control the frequency of contraction of the ureters. In addition, if the exercises are performed incorrectly, there may be a lack of effect and even a pathological spasm that occurs with excessive physical activity.

There is a method of prolonged passage of urine, designed for drainage of the upper urinary tract, and a device for its implementation. The device for a long passage of urine is made of silicone rubber in the form of a tube with side openings and a wall thickness of 0.1 - 0.2 mm. With prolonged passage of urine from the pyelocaliceal system to the bladder, the vesicoureteral reflex does not develop (see RF patent No. 2113245, IPC A61M 27/00, A61M 25/00).

The disadvantage is the invasive introduction of the stent into the urethra. When carrying out this method, direct damage to the walls of the urinary tract, as well as the attachment or strengthening of the inflammatory process, which also limits the application of this method, is possible. Application of the method requires advanced training of medical staff.

The closest is the method of galvanic-acoustic stimulation and a device for its implementation. In this method, in addition to acoustic stimulation, electric vibrations are simultaneously excited in the patient’s body and topologically combined with acoustic vibrations (see application for invention of the Russian Federation No. 94027257, IPC A61H 23/00). For the treatment of atony of the upper urinary tract, a device is used that contains a generator of electrical vibrations of sound frequency and an emitter of sound vibrations connected to its output, containing a movable element, such as a membrane. The device contains at least one pair consisting of positive and negative electrodes made of electrically conductive materials with different electrochemical potentials, the positive electrode of each pair being connected to the positive power supply bus of the generator, and the negative to the negative power supply bus of the generator, and the movable radiator element, for example, the membrane is combined with one or more positive and / or negative electrodes or is itself one of the electrodes. Acoustic emitters of sound vibrations are connected to the output of the generator, and the movable element of each of them is combined with its own electrode or directly is it.

The disadvantage of this method is the predominant effect on the system of blood vessels and a minimal effect on the ureters. Another disadvantage of this method is the manual selection of the frequency of the signal and the high amplitude of the radiation. Using this method, it is difficult to set and adjust the frequency of contraction of the ureters. The use of acoustic exposure for some diseases has contraindications.

The objective of the invention is to create a new non-invasive method of restoring the tone, contractile and evacuation ability of the upper urinary tract, contributing to a more rapid relief of exacerbation, as well as reducing the number of exacerbations of pyelonephritis, applicable in general practice, including pediatrics, not only in hospitals, but also in clinics.

The technical result consists in increasing the accuracy of the therapeutic effect and, as a result, increasing the efficiency and reducing the treatment time.

The specified technical result is achieved by the fact that the method of promoting the passage of urine in the ureter involves the excitation of electrical oscillations in the patient’s body using electrodes, according to the solution, one of the electrodes is located in the pubic bone, and the others are paravertebral along the outer edge of the muscle straightening the spine in the area between XII rib and sacral region, and the excitation is carried out as follows: the paravertebral electrodes located closest to the XII rib send a signal with a frequency from the interval 5-32 kHz, with an amplitude of not more than 3 V, current strength of not more than 20 mA, formed into a pulse with a duration of 0.1-0.2 ms, pulses are formed into a packet with a duration of 0.5-1 sec, the time between pulses in a packet of 0, 01-0.8 sec, the pulse train is fed sequentially to each paravertebral located electrodes in the direction to the sacral section with a delay of 5 seconds, after applying the pulse train to the paravertebral electrodes closest to the sacral region, after 5 seconds, the pulse train is sequentially fed to the paravertebral located e XII electrodes from the rib to the sacrum card; while the excitation is carried out over a period of 5-10 minutes, 1 time per day for 5-20 days.

The invention is illustrated by drawings, where in FIG. 1 shows a block diagram of a device for implementing a method for promoting the passage of urine in the ureter (apparatus for myostimulation of urodynamics); in FIG. 2 - waveforms of the microwaves for all three pairs (upper, middle and lower) of the paravertebral electrodes; in FIG. 3 is a schematic illustration of the ureter. The positions in the drawings indicate:

1 - computer;

2 - block forming pulses;

3 - debugging module;

4 - software amplifier;

5 - upper paravertebral electrodes;

6 - middle paravertebral electrodes;

7 - lower paravertebral electrodes;

8 - common electrode;

9 - impulse;

10 - a pack of pulses.

The implementation of the method

A method of promoting passage of urine in the ureter includes the excitation of electrical vibrations in the patient’s body using electrodes. One of the electrodes is common and located in the area of the pubic bone, that is, in the bladder. Other electrodes are located paravertebrally along the outer edge of the muscle that straightens the spine, in the area between the XII rib and the sacral region, that is, along the ureters. In pediatric patients, paravertebral electrodes were taken in the amount of two, and in adult patients in the amount of six, while the electrodes are arranged in pairs symmetrically relative to the spine in three rows - the upper paravertebral electrodes in the region of the XII ribs, the lower paravertebral electrodes in the sacral region, the middle paravertebral electrodes located between the upper and lower. A device for implementing a method for promoting the passage of urine in the ureter contains an electric oscillation generator connected to the electrodes. The generator is a computer with a control program that allows you to set the desired sequence of pulses with the given parameters. The computer program is written in C # and allows real-time control of all the characteristics of the output signal of the claimed device (muscle stimulator). The generator is connected via a USB port to a pulse shaping unit consisting of a debugging module (for example, Texas Instruments MSP430G2XXX series based on the MSP-EXP430G2 brand controller) and a software amplifier block equipped with outputs for connecting to the electrodes.

The method is as follows. Using an generator and a pulse forming unit, an electrical signal is generated with a frequency of 5-32 kHz, an amplitude of not more than 3 V, and a current of not more than 20 mA. The signal is supplied by pulses with a duration of 0.1-0.2 ms, and the pulses are formed into a packet of 0.5-1 sec duration, the time between pulses in the packet is 0.01-0.8 sec. A burst of pulses is fed sequentially to each paravertebral located electrodes in the direction from the XII ribs to the sacral region with a delay of 5 seconds: first to the upper paravertebral electrodes, then after 5 seconds to the middle paravertebral electrodes, and then after 5 seconds to the lower paravertebral electrodes. After applying a packet of pulses to the lower, paravertebral located electrodes closest to the sacral section, after 5 seconds, a sequential supply of a packet of pulses to the paravertebral located electrodes from the XII rib to the sacral section is repeated. To achieve the objective of the method, the excitation of electrical oscillations in the patient’s body is carried out for 5-10 minutes 1 time per day for 5-20 days.

During electrical stimulation, the transmission of impulses from nerve endings to muscle fibers causes muscle contraction, while blood circulation and lymph flow are improved, and metabolism is activated. The dynamics of the passage of a portion of urine through the ureter was controlled using an ultrasound apparatus with the location of the applicator in the area of the ureter's entrance into the bladder. With an increase in the amount of urine excreted by the ureter by more than 1 ml into the bladder or an increase in the rate of ejection by more than 1 cm / s, the conclusion is made about the effectiveness of these parameters of myostimulation to the ureter.

To implement the method, the patient is placed on a couch and electrodes are placed on the back. The upper electrodes are located in the corner between the outer edge of the muscle that straightens the spine and the XII rib. Subsequent - on the outer edge of the muscles that straighten the spine, from top to bottom to the sacral region. Common pubic electrode. This arrangement of the electrodes is associated with the projection of the kidneys and ureters in the lumbar region. In the best embodiment, 3 pairs of electrodes were selected, due to the structure of the ureter. There is a cystoid theory, according to which the ureter consists of three departments (cystoids), which sequentially contract and push urine from the kidney into the bladder. Each electrode is lubricated with an electrically conductive gel or saline solution. Then they turn on the program on the computer and set the minimum values of all adjustable parameters, after which they press the "START" button in the program interface. By varying the amplitude and pulse repetition rate, the quantitative characteristics of the ureteric discharge into the bladder are simultaneously monitored by ultrasound.

Electrical stimulation begins to be carried out once a day for 5-10 minutes by pulses grouped in a pack of 1 second duration, with a voltage of 2-3 V in a pulse, current strength in a pulse of up to 20 mA, a delay time of supply of pulses between adjacent pairs of contact surfaces for 5 seconds . As a result of this, 5 excitation cycles are formed in 1 minute, which corresponds to the physiological contraction of the ureter. If the ureteric outlet increases (speed, volume, frequency of contractions), a conclusion is drawn about the effectiveness of urodynamic myostimulation. At the end of the procedure: turn off the program, turn off the pulse forming unit, remove the electrodes, remove the remnants of the conductive gel.

The theoretical basis of the method

The proposed stimulation mode is optimal for obtaining a stable therapeutic effect and is selected on the basis of a study of literature, well-known stimulation techniques and clinical observations of 21 patients. When implementing the method, an assessment was made of the functional activity of the ureters using ultrasound with the definition of ureteral emissions. In the IDM mode, quantitative parameters were estimated: the number of peaks (waves), the number of emissions per unit time, the duration of one emission (T), the maximum (Vmax) and minimum (Vmin) emission rates.

In accordance with the continuity condition, as the section of the channel narrows, the speed of the continuous flow inside it increases in proportion to this narrowing. As a result, as the channel cross section decreases, the resistance to the fluid flow increases and its movement becomes more and more difficult.

Since all the liquid in the channel is assumed to be inert and driven only by external force, along the entire length of the channel it experiences only resistance to movement and braking, which, due to the incompressibility of the liquid, is fully transmitted to the channel entrance. At the same time, the narrowing of the channel increases the resistance, and therefore, to improve throughput, all other things being equal, it is necessary to increase its diameter.

As shown in FIG. 3, we will place at least three control and stimulation points in the study area — p1, p2, p3. Then the time between sections will be t1 and t2, respectively. Based on the anatomical data, we assume the following boundary conditions:

L (total length) = 20 cm = 0.2 m;

Vmin (minimum speed) = 2.3 cm / s = 0.023 m / s;

Vmax (maximum speed) = 60 cm / s = 0.6 m / s.

If we assume that the channel section one has the same value as the second channel section and is equal to 7 cm, then we estimate the time it takes for the pulse wave to pass through the control points:

t2 = t1 => min 0.07 / 0.0.23 = 3.04 seconds

 max 0.07 / 0.6 = 0.12 seconds

Accordingly, the frequency of passage of waves of the passage of urine can vary from min 1 / 3.04 = 0.32 Hz to max 1 / 0.12 = 8.3 Hz.

Method implementation examples

A survey of children with chronic pyelonephritis was conducted. A violation of the urodynamics of the urinary tract was detected. When assessed by ultrasound of the ureteral emissions, a decrease was found in both the maximum and minimum rates of ureteral emissions (90%).

After electromyostimulation, an increase in the rate of ureteric discharge was noted, as well as an increase in the duration of the ureteric discharge, which indicates normalization of the urodynamics of the urinary tract.

Thus, the proposed method for restoring the urodynamics of the upper urinary tract allows you to restore the tone, contractile and evacuation ability of the upper urinary tract, which reduces the duration of exacerbation and the number of exacerbations of pyelonephritis, which are associated with a violation of urodynamics. This method is non-invasive, which allows it to be used in pediatrics, as well as not only in a hospital, but also in outpatient practice.

Example 1

Patient N., 15 years old, was in CPF (Department of Faculty Pediatrics, Saratov State Medical University named after V.I. Razumovsky) with a diagnosis of Secondary obstructive and dysmetabolic pyelonephritis, chronic course, period of remission, without impaired renal function. VAMS: an intrarenal vessel on the right.

From the anamnesis it is known that the girl has been on a dispensary account with a nephrologist with this diagnosis since 2001.

The clinic conducted a survey.

In the general analysis of blood: no inflammatory changes. Blood biochemistry: without pathology. In the general analysis of urine: no inflammatory changes.

Ultrasound of the kidneys was performed: moderate pyeloectasia on the right was revealed.

Excretory urography: kidneys give out contrast in a timely manner. On the right is moderate pyeloectasia, an intrarenal vessel.

The left pelvis is normal.

Mixed cystourethrography: no reflux revealed.

In order to study the urodynamics of the upper urinary tract, a determination of the ureteric emissions was carried out. A decrease in both the maximum and minimum emission rates was revealed: Vmax on the right 19.2 cm / s, Vmax on the left 30 cm / s (norm 51.0 ± 0.03 cm / s);

Vmin on the right is 3 cm / s, Vmin on the left is 4.2 cm / s (norm 17.9 ± 0.02 cm / s), the duration of emissions on the right is 1300 ms, on the left 2533 ms. The number of emissions in 1 minute on the right 2, left 3.

To improve the urodynamics of the upper urinary tract, electromyostimulation was performed.

The procedure is carried out once a day, for 5-10 minutes with a switching frequency of the electrodes of 500 ms. Pause between cycles 5 sec. The duration of the pulse train is 1000 ms. In the subsequent procedure, extended to 20 minutes The course is 10 days.

After the course of electrical stimulation, a control study of the urodynamics of the upper urinary tract was carried out by determining the ureteric emissions. It was found that the maximum and minimum speeds increased, on the right it was Vmax on the right 30.2 cm / s, Vmax on the left 42 cm / s, Vmin on the right 9 cm / s, Vmin on the left 8.2 cm / s, duration of emissions on the right 1300 ms, left 1533 ms. The number of emissions in 1 minute on the right 4, left 3.

Example 2

Patient N., 13 years old, was in CPF with a diagnosis of Secondary dysmetabolic pyelonephritis, a chronic course, a period of incomplete remission, without impaired renal function.

From the anamnesis it is known that the girl has been in the dispensary registration with a nephrologist since 2009.

The clinic conducted a survey.

In the general analysis of blood: no inflammatory changes. Blood biochemistry: without pathology. In the general analysis of urine: without inflammatory changes, a small amount of oxalates.

Ultrasound of the kidneys: no pathology. Excretory urography: the kidneys are located in the usual place, the contrast is distinguished in a timely manner. Right and left pelvis are somewhat hypotonic. The ureters are passable, somewhat hypotonic.

According to the MCUG: no reflux revealed.

In order to study the urodynamics of the upper urinary tract, a determination of the ureteric emissions was carried out. A decrease in both the maximum and minimum emission rates was revealed: Vmax on the right 8.9 cm / s, Vmax on the left 9.1 cm / s (norm 40.0 ± 0.03 cm / s);

Vmin on the right is 2.5 cm / s, Vmin on the left is 2.3 cm / s (norm 14.0 ± 0.02 cm / s), the duration of emissions on the right is 1258 ms, on the left 2858 ms. The number of emissions per 1 minute on the right 2, left 2.

To improve the urodynamics of the upper urinary tract, electromyostimulation was performed.

The procedure is carried out once a day, for 5-10 minutes with a switching frequency of the electrodes of 500 ms. Pause between cycles 5 sec. The duration of the pulse train is 1000 ms. In the subsequent procedure, extended to 20 minutes The course is 10 days.

After the course of electrical stimulation, a control study of the urodynamics of the upper urinary tract was carried out by determining the ureteric emissions. It was found that the maximum and minimum speeds increased, on the right it was Vmax on the right 15.9 cm / s, Vmax on the left 17.1 cm / s, Vmin on the right 7.5 cm / s, Vmin on the left 8.3 cm / s , the duration of emissions on the right is 1958 ms, on the left 2958 ms. The number of emissions per 1 minute on the right 3, left 4.

Thus, the proposed method for restoring the urodynamics of the upper urinary tract allows you to restore the tone, contractile and evacuation ability of the upper urinary tract. Thus, with the normalization of urodynamics, the duration of exacerbation and the number of exacerbations of pyelonephritis are reduced, because violation of urodynamics is one of the main components of the development of pyelonephritis. This method is non-invasive, which allows it to be used in pediatrics, and in children of any age, as well as not only in a hospital, but also in outpatient practice.

Example 3

Patient L., 7 years old, was in CPF with a diagnosis of Secondary dysmetabolic pyelonephritis, a chronic course, a period of incomplete remission, without impaired renal function.

From the anamnesis it is known that the girl has been in the dispensary registration with a nephrologist since 2011.

The clinic conducted a survey.

In the general analysis of blood: no inflammatory changes. Blood biochemistry: without pathology. In the general analysis of urine: no inflammatory changes. Ultrasound of the kidneys: no pathology. Excretory urography: the kidneys are located in the usual place, the contrast is distinguished in a timely manner. Right and left pelvis are somewhat hypotonic. The ureters are passable, somewhat hypotonic.

According to the MCUG: no reflux revealed.

In order to study the urodynamics of the upper urinary tract, a determination of the ureteric emissions was carried out. A decrease in both the maximum and minimum emission rates was revealed: Vmax on the right 11.9 cm / s, Vmax on the left 9.9 cm / s (norm 40.0 ± 0.03 cm / s);

Vmin on the right is 5.5 cm / s, Vmin on the left is 5.3 cm / s (norm 14.0 ± 0.02 cm / s), the duration of emissions on the right is 1258 ms, on the left 2858 ms. The number of emissions per 1 minute on the right 3, left 4.

To improve the urodynamics of the upper urinary tract, electromyostimulation was performed.

The procedure is carried out once a day, for 5-10 minutes with a switching frequency of the electrodes of 500 ms. Pause between cycles 5 sec. The duration of the pulse train is 1000 ms. The course is 10 days.

After the course of electrical stimulation, a control study of the urodynamics of the upper urinary tract was carried out by determining the ureteric emissions. It was found that the maximum and minimum speeds increased, on the right it was Vmax on the right 24.9 cm / s, Vmax on the left 23.1 cm / s, Vmin on the right 15.5 cm / s, Vmin on the left 17.3 cm / s , the duration of emissions on the right is 1958 ms, on the left 2958 ms. The number of emissions per 1 minute on the right 5, left 5.

Thus, the proposed method for restoring the urodynamics of the upper urinary tract allows you to restore the tone, contractile and evacuation ability of the upper urinary tract. With the normalization of urodynamics, the duration of exacerbation and the number of exacerbations of pyelonephritis are reduced, because violation of urodynamics is one of the main components of the development of pyelonephritis. This method is non-invasive, which allows it to be used in pediatrics, and in children of any age, as well as not only in a hospital, but also in outpatient practice.

Claims (1)

A method of promoting urinary passage in the ureter, including the excitation of electrical vibrations in the patient’s body using electrodes, characterized in that one of the electrodes is located in the pubic bone and the others are paravertebral along the outer edge of the muscle straightening the spine in the region between the XII rib and sacral department, and the excitation is as follows:
- the paravertebral electrodes located closest to the XII ribs provide a signal with a frequency in the range of 5-32 kHz, amplitude of not more than 3 V, current of not more than 20 mA, formed into a pulse with a duration of 0.1-0.2 ms,
- pulses form in a pack of 0.5-1 sec duration, the time between pulses in a pack of 0.01-0.8 sec,
- a packet of pulses is supplied sequentially for each paravertebral located electrodes in the direction of the sacral section with a delay of 5 seconds,
- after applying a packet of pulses to the paravertebral located electrodes closest to the sacral section, after 5 seconds, a sequential supply of a packet of pulses to the paravertebral located electrodes from the XII rib to the sacral section is repeated;
while the excitation is carried out for 5-10 minutes, 1 time per day for 5-20 days.

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