RU2702607C1 - Method for treating bladder tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to phthisiourology, and can be used for treating bladder tuberculosis. That is ensured by intravenous introduction of pyrazinamide and levofloxacin in the morning immediately after breakfast. It is followed by intravenous drop-by-drop introduction of isoniazid in amount of 10 mg/kg of body weight diluted in 200 ml of normal saline. After that, the patient empties the bladder and is exposed to microclyster containing 0.5 % novocaine 20 ml, dimexide 2 ml, halidor 2 ml, and rifampicin 600 mg. Additionally, the urinary bladder is instilled with Longidaza 3000 IU solution dissolved ex temporo in 20 ml of sterile physiological solution, for 2 times a week, course – 10 procedures.

EFFECT: such implementation of the method provides achieving a therapeutic effect, eliminating the possibility of fibrosis with good tolerance of patients, no need for anaesthesia, possibility of performing in out-patient conditions.

1 cl, 1 ex

Description

The invention relates to medicine, namely to phthisiourology.

Genitourinary tuberculosis ranks second in frequency in the incidence of extrapulmonary tuberculosis. Modern polychemotherapy is highly effective for tuberculosis of any localization, if treatment is started in the early stages. The healing of tuberculous inflammation occurs through the formation of a scar, which leads to recovery from pulmonary tuberculosis, but may result in the loss of organ function in genitourinary tuberculosis, when we get "a desired scarring in an undesirable place." Fibrosis of tuberculous ulcers may result in the formation of stricture of the ureter or wrinkling of the bladder.

In order to prevent excessive formation of fibrous tissue in phthisiourology, the enzymes imosimase and terrilithin were prescribed (Yagafarova R.K., Vakhmistrova T.I., Titarenko O.T. The use of physiotherapy with terrilithin in the complex treatment of patients with urinary tract tuberculosis. 10th All-Union Congress of TB Specialists: Abstracts Kiev, 10986.-p. 13). However, the enzymes used in the known methods were short-lived, the rapid decomposition of the active substance did not allow to have a prolonged effect.

A known method of treating chronic cystitis (RU 2626594 C1, 05.20.2016) by intravesical instillations with an additional effect on the mucous membrane of sodium - aluminogranate with neodymium (YAG-Nd) laser, conducting point coagulation. The known method is effective for chronic bladder pain syndrome, especially associated with venous congestion, but it does not prevent the overproduction of fibroblasts.

A known method of treating spastic tuberculosis microcystis (RU 2527905 C1, 06/19/2013), when against the background of anti-tuberculosis chemotherapy, epidural anesthesia is performed and laser therapy is additionally performed on biological active points. The known method allows you to stop the spastic contraction of the bladder and maintain / restore its capacity, but does not affect the pathogenesis of the disease and does not eliminate the possibility of developing fibrosis of the bladder in the future.

There is a method of preventing the development of microcystis in patients with bladder tuberculosis (RU 2372910 C1, 07/21/2008) by polychemotherapy, characterized in that isoniazid is administered by the indirect lymphotropic method, and rifampicin in the composition of the medicinal boiler is novocaine 0.5% -50 ml + rifampicin 0.6 + dimexide 5 ml - microclyster, and an additional spasmex is prescribed. The known method allows you to stop the hyperactivity of the bladder, characteristic of tuberculosis of the bladder of the 3rd stage. The disadvantages of the method is the large volume of microclysters, which in some patients can cause a laxative effect; Spazmeks has a number of contraindications, in particular, closed-angle glaucoma. Also, this method stops the consequences of an already formed complication, without affecting its pathogenesis.

A known method for the treatment of bladder tuberculosis (patent No. 2289354) by exposure to a surgical YAG Nd laser at 5-8 points of the bladder mucosa, however, this method is a surgical intervention, requires general anesthesia (intravenous or mask anesthesia), which limits its use.

The inventive method of treating bladder tuberculosis, characterized in that isoniazid is administered intravenously, rifampicin is prescribed in microclysters with dimexide, pyrazinamide and levofloxacin are given in tablets, then the bladder is instilled with a solution of Longidase 3000 ME, and polychemotherapy is carried out daily, and 2 times a day, twice a day. a week, a course of 10 procedures, does not require pain relief, is well tolerated by patients, eliminates the possibility of developing fibrosis of the bladder in the future, can be performed on an outpatient basis.

The method is as follows. In the morning immediately after breakfast, the patient takes pyrazinamide and levofloxacin inside, then isoniazid is administered dropwise to him at the rate of 10 mg / kg body weight, diluted in 200 ml of physiological saline. After that, the patient empties the bladder, and he is given a microclyster containing 20 ml of novocaine 0.5%, 2 ml of dimexide, 2 ml of halidor and 0.6 rifampicin. After that, the external opening of the urethra is treated with a gauze swab moistened with an aseptic solution (for example, an aqueous solution of chlorhexidine), and a Nelaton catheter lubricated with a lubricant (for example, catigel) is passed through the urethra. Make sure by the absence of urine that the bladder is empty, and instill 3000 ME of longidase dissolved ex temporo in 20 ml of sterile physiological saline, and dissolving is carried out by gentle shaking, avoiding foaming of the solution. After instillation, the catheter is removed, and the patient is advised to refrain from urinating for at least 2 hours.

Example. Patient D., 47 years old. Complaints of general weakness, malaise, increased fatigue, constant aching pain in the lumbar region on the left, frequent painful urination.

Considers herself a patient for five years, when she first became ill with acute cystitis. The ciprofloxacin prescribed by the doctor of the clinic had an incomplete and short-term effect. With short breaks all this time, the patient noted discomfort when filling the bladder, increasing dysuria. Repeatedly went to the doctors, received therapy for "chronic cystitis", but the relief did not occur.

2 months ago, renal colic appeared on the left, the patient was hospitalized in the urology department, where a picture suspicious of urotuberculosis was obtained on an excretory urogram.

The patient was transferred to the urogenital department of the FSBI NNIIT of the Ministry of Health of the Russian Federation.

Objectively. The condition is satisfactory. Adequate food. The skin is warm, normal color and moisture. Mucous pink, moist. Body temperature 37.2 °. The tongue is clean, moist. The abdomen is soft, painful on palpation above the womb. The symptom of Pasternatsky is weakly positive on the left.

Complete blood count: white blood cells 8.6 * 10 ⁹ / ml, ESR 45 mm / hour. General analysis of urine: white blood cells 55-60 in the field of view, red blood cells - 10-12 in the field of view. MSCT: cavities of destruction of the parenchyma of the left kidney are determined.

Cystoscopy: the urethra is clear. The bladder capacity is 170 ml, with further filling - pain. The mucous membrane is hyperemic, injected with full-bloomed convoluted vessels. On the back and right wall - multiple rashes of a yellowish color in a round shape. Ulcers are not visualized.

A biopsy of the bladder wall was performed; histologically - lymphoid infiltration, giant Pirogov - Langgans cells. According to the diary of urination, the volume of the bladder ranged from 40 to 160 ml; during the day, the patient made 24 miktsia, at night - 5. The intensity of pain on a visual-analogue scale was rated at 7 points.

The method of molecular genetic diagnosis identified M. tuberculosis in the urine. The patient was diagnosed with cavernous tuberculosis of the left kidney, tuberculosis of the bladder, MBT +.

Concomitant diseases: type 2 diabetes mellitus, compensation. Closed-angle glaucoma, chronic stoneless cholecystitis.

The patient started treatment: in the morning immediately after breakfast, she took pyrazinamide and levofloxacin inside, then she was injected intravenously with isoniazid at the rate of 10 mg / kg body weight, diluted in 200 ml of physiological saline. Then they offered to urinate, and after emptying the bladder she was given a microclyster containing 20 ml of novocaine 0.5%, 2 ml of dimexide, 2 ml of halidor and 0.6 rifampicin. After that, the external opening of the urethra was treated with a gauze swab moistened with an aseptic chlorhexidine solution, and a Nelaton catheter was lubricated through the urethra, lubricated with a cathejel for lubrication. Since urine did not flow through the catheter, it was ascertained that the bladder was empty and 3,000 IU of longidase, dissolved ex tempore in 20 ml of sterile physiological saline were instilled, instillations were performed 2 times a week, in a course of 10 procedures. Within two hours after instillation, the patient refrained from urinating.

Two months later, normalization of the general analysis of blood began, a significant improvement in the general analysis of urine: (the number of leukocytes decreased to 8-10 in the field of view, erythrocytes - 0). According to the urination diary, the number of miktsii decreased by day to 10-12, at night - to 0-2. Pain - 3 points.

With a control cystoscopy after two months, the pink mucosa, the mouths are slit-like, are located in a typical place, the rashes on the back and right side walls are isolated, faded; bladder volume increased to 250 ml.

A method for treating the bladder with anti-TB drugs, characterized in that isoniazid is administered intravenously, rifampicin is prescribed in microclysters with dimexide, pyrazinamide and levofloxacin are given in tablets, and the bladder is instilled with a solution of Longidase 3000 ME, and polychemotherapy is carried out 2 times a day, and week, 10 courses of procedures, tested in the urogenital clinic of the FSBI NNIIT of the Ministry of Health of the Russian Federation in 6 patients.

Initially, the volume of the bladder was 130 ± 27 ml, the frequency of urination during the day averaged 18 ± 4 micions, at night - 4 ± 2 microns; the intensity of pain on a visual analogue scale averaged 8.3 ± 1.2 points.

The inventive method does not have an instantaneous effect, it takes time to disintegrate the formed fibroblasts, start repair processes, restore microcirculation, therefore, the result was evaluated two months after the start of complex treatment. The volume of the bladder on average increased to 247 ± 14 ml, the frequency of daily urination decreased to 9 ± 2.8 mikitsi1, at night - 1 ± 0.6 mikitsii; the intensity of pain on a visual analogue scale on average decreased to 2.2 ± 0.2 points.

The treatment was well tolerated; in no case did any significant side effect develop.

Thus, the claimed method of treating the bladder with anti-TB drugs, characterized in that isoniazid is administered intravenously, rifampicin is prescribed in microclysters with dimexide, pyrazinamide and levofloxacin are given in tablets, and the bladder is instilled with a solution of longitudinal ME 3000 ME, and chemotherapy is carried out daily; instillation 2 times a week, a course of 10 procedures is highly effective, simple to perform, well tolerated by patients, does not require additional equipment or anesthesia, does not require ie additional training of specialists, can be performed on an outpatient basis.

Claims (1)

A method of treating bladder tuberculosis with anti-TB drugs, characterized in that in the morning, immediately after breakfast, pyrazinamide and levofloxacin are administered inside, then isoniazid is administered dropwise at a rate of 10 mg / kg body weight diluted in 200 ml of saline, after which the patient empties the urinary a bubble and he is given a microclyster containing 20 ml of novocaine 0.5%, 2 ml of dimexide, 2 ml of halidor and 600 mg of rifampicin; additionally, bladder installations are performed with a solution of 3000 IU longidase, dissolved ex temporo in 20 ml of sterile physiological saline, 2 times a week, 10 course procedures.