RU2847431C1 - Method for treating chronic cystitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the invention relates to medicine, specifically urology. Nine millilitres of whole blood is taken from the patient's vein immediately before the instillation procedure. Plasma is obtained by centrifuging for 10 minutes at 3,500 revolutions. Add 5 ml of lidocaine hydrochloride 20 mg/ml, 10 ml of 1% dioxidine solution, 1 ml of triamcinolone acetonide 40 mg/ml, and 2.5 g of estradiol 600 mg/g to the plasma. This combination of drugs is used for bladder instillation at a rate of one instillation per week, with a course of ten instillations.

EFFECT: exfoliation of the epithelium of the bladder mucosa and a pronounced anti-inflammatory effect.

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Description

The proposed method pertains to medicine, specifically urology. It can be used for the conservative treatment of chronic cystitis.

Chronic cystitis (also known as interstitial cystitis or painful bladder syndrome) is a recurring condition characterized by prolonged inflammation, which ultimately leads to structural and functional changes in the bladder wall. It often occurs alongside various bacterial infections, but can also have a non-infectious origin. According to medical statistics, 35% of cases of cystitis occur, and 10% of those affected develop acute cystitis into a chronic condition. The underlying mechanism is not yet fully understood, and therefore, there is currently no definitive, generally accepted approach to its treatment.

In modern practice, protargol solution, preparations based on sodium alginate with lidocaine and derinat, and preparations based on sodium hyaluronate are used for bladder instillation.

The closest technical approach to our proposed method is the use of sodium alginate-based preparations with lidocaine and Derinat. This method involves the patient urinating before the procedure, introducing the room-temperature preparation into the bladder through a urethral catheter for at least 30 minutes, and then asking the patient to urinate. A disadvantage of this method is that it does not exfoliate the bladder mucosa and does not have a pronounced anti-inflammatory effect.

Also known is a method for combining bladder instillation preparations with increased storage stability, containing chondroitin sulfate (4.5 mg/ml), hyaluronic acid (16 mg/ml) and a phosphate buffer (pH 6.1-7.9) (RU 2 742 277 C1). The composition contains effective amounts of chondroitin sulfate or a physiologically compatible salt of chondroitin sulfate, hyaluronic acid or a physiologically compatible salt of hyaluronic acid, a dihydrogen phosphate/monohydrogen phosphate buffer system at a weight ratio of dihydrogen phosphate to monohydrogen phosphate in the range from 1:5 to 1:25, a physiologically compatible electrolyte, wherein the pH of the composition is from 6.1 to 7.9. The disadvantage of this method is that this drug does not affect the exfoliation of the epithelium of the bladder mucosa, does not have a pronounced anti-inflammatory effect and does not have a local anesthetic effect.

We are the first to propose a method for the conservative treatment of chronic cystitis associated with hypoestrogenism using a combination of medications for bladder instillation. The essence of the proposed method is that a combination of medications is used for bladder instillation, prepared immediately before the procedure.

According to the proposed method, the combination of drugs for instillation consists of platelet-rich autoplasma obtained after centrifugation of the patient's whole blood for 10 minutes at 3500 rpm, collected from a vein immediately before the instillation procedure (the resulting plasma is obtained from 9 ml of whole blood, individually), 5 ml of lidocaine hydrochloride 20 mg/ml, 10 ml of 1% dioxidine solution, 1 ml of triamcinolone acetonide 40 mg/ml, and 2.5 g of estradiol 600 mg/g. The mixture is prepared immediately before instillation. The patient is placed on a gynecological chair or couch; after treating the external genitalia with an antiseptic, the prepared mixture is introduced through a urethral catheter moistened with lubricant into the bladder. The solution is retained in the bladder for at least 30 minutes but no more than one hour, after which the patient is asked to urinate. The course of treatment involves 3 to 10 instillations, with a frequency of one instillation per week.

Clinical example.

A 50-year-old woman consulted a urologist complaining of recurrent cystitis. She had been reporting these complaints for 6 years. She periodically self-medicated with furadonin and nolitsin without the desired long-term effect. She also underwent a course of bladder instillations with hyaluronic acid-based preparations, which she noted to be of short-lived effect. On examination: general urine analysis: unremarkable. bladder ultrasound: unremarkable. kidney ultrasound: signs of non-specific changes in the sinuses of both kidneys. medical history: unremarkable: no history of allergies, denies viral hepatitis, tuberculosis, or venereal diseases. She grew and developed normally. St. praesens: her condition is satisfactory. The skin and visible mucous membranes are of normal color. There is no edema. Temperature is N. Peripheral lymph nodes are not enlarged. Nasal breathing is not difficult, there is no nasal discharge. The chest is of normal shape. Both sides of the chest are symmetrically involved in the act of respiration. Palpation of the chest is painless. Percussion reveals a pulmonary sound over the lungs. In the lungs, breath sounds are vesicular, no wheezing is present. Respiratory rate is 18 beats per minute. Heart sounds are rhythmic, clear, heart rate is 68 beats per minute. The abdomen is soft on palpation, not distended, painless over the pubis on palpation, the kidneys are not palpable in any position. The lumbar region is visually unchanged, percussion is negative on both sides. The gynecological history is unremarkable. Perimenopause is noted. During cystoscopy, an irregularly shaped area, slightly elevated above the mucosa (corresponding to an area of chronic inflammation), is detected in the area of the bladder neck. The patient was offered a course of instillations with a combination of autologous plasma obtained immediately before the instillation procedure, after centrifuging 9 ml of the patient's whole blood for 10 minutes at 3500 rpm, lidocaine hydrochloride 20 mg / ml (5 ml), 1% dioxidine solution (10 ml), 1 ml of triamcinolone acetonide (40 mg / ml), estradiol 600 mg / g (2.5 g). Instillations were performed once a week, a total of ten instillations per course. After the second instillation, the level of pain, discomfort during urination, and frequency of urination decreased. After the course of instillations, the patient was observed by a urologist for six months, monthly submitting a general urine analysis and filling out the VAS pain scale. No relapses were noted. Further monitoring by a urologist with a course of instillations once a year is recommended.

Bibliography

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3. Kasyan GR, Kupriyanov YuA, Karasev AE, et al. Results of a multicenter, double-blind, placebo-controlled, randomized study of the efficacy and safety of pentosan polysulfate in patients with painful bladder syndrome/interstitial cystitis. In: XIV Congress and XXII Congress of the Russian Society of Urologists; September 14-17; Moscow; 2022. P. 548-549. Available from: rou_tezisy_1_el.pdf - Google Drive. The link is active on December 12, 2022.

4. Soha Patil, Gabrielle Daniek, Yogita Tailor et al. Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections. Available at: Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections - PubMed (nih.gov). Accessed: 14 December 2022.

5. Hidetoshi Tabata, Masanori Sasaki, Yuko Kataoka - Sasaki et al. Possible role of intravenous administration of mesenchymal stem cells to alleviate interstitial cystitis/bladder pain syndrome in a Toll-like receptor-7 agonist-induced experimental animal model in rat. Available at: Possible role of intravenous administration of mesenchymal stem cells to alleviate interstitial cystitis/bladder pain syndrome in a Toll-like receptor-7 agonist-induced experimental animal model in rat - PubMed (nih.gov). Accessed: 14 December 2022.

Claims (1)

A method for treating chronic cystitis, characterized in that 9 ml of whole blood is taken from the patient's vein immediately before the instillation procedure, plasma is obtained by centrifugation for 10 minutes at 3500 rpm, 5 ml of lidocaine hydrochloride 20 mg / ml, 10 ml of 1% dioxidine solution, 1 ml of triamcinolone acetonide 40 mg / ml, 2.5 g of estradiol 600 mg / g, this combination of drugs is used for instillation of the bladder in a course of one instillation per week, while the course is ten instillations.