The therapeutic effect of the paraffin-containing Physomed belt
The therapeutic effect of the paraffin-containing Physomed belt may also be explained by the fact that the warming effect paraffin has on the skin receptors in the lumbar region normalizes kidney hemodynamics, increases diuresis, and improves function of the upper urinary tracts in patients with urolithiasis through reflexes exerted by the vegetative nervous system and the spinal centres. This in turn ensures faster and pain-free passage of fine stones and their fragments following extracorporal shock-wave lithotripsy (Sitdykov E. N., 2003).
In the present study, we tried to evaluate the utility of the Fizomed (Nephromed) belt in the comprehensive treatment of patients with urolithiasis who have undergone extracorporal shock-wave lithotripsy (ESWL). To achieve this, we formulated the following study tasks:
1/ to assess useful effects of the Fizomed (Nephromed) belt in the comprehensive post-ESWL treatment aiming to prevent renal colics and relieve the developing one.
2/ to evaluate the physiotherapeutic effect of Fizomed (Nephromed) belt use that helps improve passage of concrement fragments.
Description of clinical results. The paraffin-containing therapeutic FIZOMED (NEPHROMED) belt was applied in this study in 30 patients with urolithiasis who had had ESWL (main group); the belt was chosen according to the patient’s waist circumference and attached to the small of the back. Subjects included 21 males (70%) and 9 females (30%).
In the control group, the time to passage of stone fragments following ESWL and severity of postoperative pain syndrome were estimated in 30 patients with the same postoperative care regimen (spasmolytics, nonsteroidal anti-inflammatory drugs). This group was comprised of 18 males (60%) and 12 females (40%).
All patients were administered comprehensive clinical evaluation, which included laboratory (common clinical and chemical tests of blood and urine) tests and radiation (ultrasonic and X-ray) imaging. The patient distributions according to concrement sites are shown in Tables №1-2.
Table №1. Patient distribution (main group) according to concrement sites (n=30)
Therefore, 18 subjects (60%) in the main group were diagnosed with kidney concrements and 12 subjects (40%), with ureteral calculi.
Table №2. Patient distribution (control group) according to concrement sites (n=30)
In the control group, 16 subjects (53.3%) had kidney concrements and 14 subjects (46.7%) had calculi in the ureter.
In the main group, calculi measuring 6-9 mm were found in 21 patients and stones 10-12 mm in diameter, in 9 subjects. In the control group, concrements were 6-9 mm in dimensions in 22 patients and 10-12 mm, in 8 subjects (these data are demonstrated by Table №3).
Table №3. Patient distribution according to concrement size
Extracorporal shock-wave lithotripsy was performed using the “Siemens. Modularis Uro Plus” device. One more lithotripsy procedure was required in 4 patients in the control group.
Study results. The clinical evaluation of pain severity (F. M. Ferrante, T. R. WeidBoncor 1998) involved the use of the 10-centimetre ranking visual analog scale (VAS). The pain level during post-ESWL stone passage was “5-7” points, whereas achieving the “0” pain score was regarded as cured renal colic (data shown in Tables №4-5).
In order to prevent and relieve renal colics accompanying passage of concrement fragments, we used spasmolytics and nonsteroidal anti-inflammatory drugs (dexalgin, voltaren etc.) at the same doses both in the main and control groups.
Table №4. Pain-relieving efficacy in post-ESWL stone passage in the main study group (n=30)
In the main study group, renal colics therefore were cured by administration of spasmolytics and nonsteroidal anti-inflammatory drugs in all 30 patients within 15 minutes, but the time to maximum effect was different. In 5 minutes, the renal colic was cured in 19 patients (63.3%) and in 15 minutes, in 11 subjects (36.7%).
Within the first day of treatment, patients using the belt noted the disappearance of chronic lumbar discomfort (heaviness, burning, and tingling) and the presence of mild enjoyable warmth, which lasted throughout the therapeutic period of Fizomed (Nephromed) belt use.
Table №5. Pain-relieving efficacy in post-ESWL stone passage in the control study group (n=30)
In the control study group, renal colics were cured in 7 patients (23.3%) within 5 minutes, in 18 subjects (60%) within 15 minutes, and in 5 patients (16.7%) within 30 minutes. However, 2 patients developed indications for upper urinary tract catheter-stent drainage due to a recurrent renal colic and relapsing attacks resulting from ureteral obstruction with stone fragments and pronounced dilatation of the calicopelvic system.
Therefore, the use of the paraffin-containing therapeutic FIZOMED (NEPHROMED) belt (considering the supposed therapeutic effect) accompanied by administration of antispasmodics and nonsteroidal anti-inflammatory drugs, allows to cure renal colics significantly faster and to ensure painless passage of concrement fragments. In the main group, the renal colic was cured in 19 patients (63.3%) in 5 minutes and in 11 subjects (36.7%) in 15 minutes; in the control group, the attack was relieved in 7 patients (23.3%) within 5 minutes, in 18 subjects (60%) within 15 minutes, and in 5 patients (16.7%) within 30 minutes. Two patients in the control group developed indications for upper urinary tract catheter-stent drainage due to a recurrent renal colic and relapsing attacks resulting from ureteral obstruction with stone fragments and pronounced dilatation of the calicopelvic system.
Passage of concrement fragments following extracorporal shock-wave lithotripsy in the main group was observed in 17 patients (56.7%) within 2-5 days and in 13 subjects (43.3%), within 6-7 days after ESWL. In control group patients, passage of concrement fragments following extracorporal shock-wave lithotripsy was observed in 12 subjects (40%) within 5 days and in 18 patients (60%), within 6-7 days after ESWL. One more lithotripsy procedure was required in 4 patients in the control group because of “stone path”-type accumulation of concrement fragments in the ureter.
Conclusion. The conducted study has demonstrated the utility of treatment with the paraffin-containing therapeutic FIZOMED (NEPHROMED) belt as a novel physiotherapeutic device included in the comprehensive treatment regimen in patients with urolithiasis. Application of this remedial belt after extracorporal shock-wave lithotripsy for renal and ureteral calculi allows to reduce intensity, frequency, and duration of renal colics. Passage of fragments of disintegrated concrements takes less time when this physiotherapeutic device is used.
Chair of Urology, I. M. Sechenov Moscow Medical Academy
(Head of Chair, Associate Member of the RussianAcademy of Medical Sciences, Prof. Yu. G. Alyaev)