The Fizomed (Nephromed) belt in the treatment of patients with urolithiasis undergoing extracorporal shock-wave nephroureterolithotripsy.
We believe that the impact of this treatment results from the warming effect paraffin has on the skin receptors in the lumbar region that enhances kidney hemodynamics, owing to decreased vascular resistance, through reflexes exerted by the vegetative nervous system and the aforementioned spinal centres. Study evidence supports this point of view. We carried out ultrasonic angiography including renal blood flow assessment using an ultrasonographic system that worked in the colour Doppler and energy mapping regimen. Resistivity (Ri) and pulsatility (Pi) indices were measured in the impulse Doppler regimen. Doppler sonography was performed prior to Fizomed (Nephromed) belt wearing, and then at 2-3 days, 9-10 days, and 2-3 months. Immediately before the paraffin-containing Fizomed (Nephromed) belt was put on, renal hemodynamics were evaluated in 50 patients with urolithiasis. In patients without urodynamic alterations, pulsatility and resistivity measures were somewhat increased, being 1.1+0.02 and 0.66+0.04, respectively /P>0.05/, which is indicative of minor deterioration of renal hemodynamics. In those with impaired urodynamics (manifest as pyeloectasia), Ri and Pi values were significantly higher, being 1.23+0.05 and 0.72+0.04, respectively. These values demonstrate impaired renal hemodynamics in patients with urolithiasis complicated by urodynamic disturbances. As the study results have demonstrated, urodynamic disturbances result in impaired renal hemodynamics, whereas hemodynamic alterations lead to deterioration of urodynamic changes in the upper urinary tract, which predispose to the development of inflammatory complications of urolithiasis. The bottom-line is that the most important objective of the treating physician should be to bring renal hemodynamics back to normal and to recover adequate evacuation of urine from the calicopelvic system. This can be achieved with the use of the Fizomed (Nephromed) belt, which, inducing skin receptors of the lumbar region, helps decrease vascular tension and improve blood circulation in the kidney. Both pelvic and ureteral hemodynamics are naturally normalized, thanks to the specific anatomy of the blood flow in the kidneys and upper urinary tract. Remitting the spastic state of the pelvicoureteral segment of the urinary system brings urine passage from the kidney pelvis back to normal and relieves the pain attack. The Fizomed (Nephromed) belt helps increase urinary excretion in the kidneys through normalization and improvement of blood afflux to the renal nephrons. The enhanced diuresis improves contractile activity in the ureter and renal pelvis. Ureteral contraction frequency in these cases, based on data obtained on roentgenourotelescopy, can be as high as 4-5 per minute (normal range - 2-3), which indirectly confirms the more active blood flow in the kidney. The positive impact of the Fizomed (Nephromed) belt on renal hemodynamics is supported by Doppler ultrasonography results obtained after extracorporal shock-wave lithotripsy. As early as on day 2 or 3 of belt wearing in pyeloectasia, pulsatility and resistivity measures were decreased with statistical significance in patients with postoperative hemodynamic impairment: from 1.59 0.06 and 0.8 10.03 to 1.15 0.07 and 0.69 0.03, respectively. By the tenth day, the corresponding values had become 1.12 0.05 and 0.67 0.04.
In ureteropyeloectasia, normalization of renal hemodynamics unfolds simultaneously with recovery of the calicopelvic system’s anatomy and function and takes 2 to 4 weeks. By that time, the Pi and Ri indices were, respectively, 0.95 0.02 and 0.62 0.05 /P<0.05/. Consequently, the daily volume of passed urine had increased as well (to 2.5 litres).
The Fizomed (Nephromed) belt therefore helps normalize renal hemodynamics, increase diuresis, and relieve the spastic state of the upper urinary tract thanks to its high calorific capacity, provided it is worn for a long time. These effects in turn lead to washing of small concrements and crystals from the surface of calculi in the calicopelvic system. The factor affecting the concrement is enhanced diuresis, which is due to the use of the Fizomed (Nephromed) belt. The faster and painless passage of pelvic concrements results from activated ureteral function.
Destruction of concrements in the pelves and calyces during extracorporal shock-wave lithotripsy is significantly easier and requires fewer impulses in patients who use the Fizomed (Nephromed) belt before extracorporal nephrolithotripsy. In these cases, the number of impulses is reduced to 2.0 – 2.5 thousand (instead of 3.5 – 4.0 thousand), which naturally decreases the time of the nephrolithotripsy procedure. We explain these findings by the altered density of concrements and their friability, which leads us to recommend wearing the Fizomed (Nephromed) belt for all patients suffering from urolithiasis.
Especially beneficial the Fizomed (Nephromed) belt may prove for patients undergoing concrement destruction by extracorporal shock-wave nephrolithotripsy, because this procedure entails deterioration of renal blood flow right at the site of shock wave action on the renal parenchyma immediately after lithotripsy. We observed the most pronounced deterioration of renal hemodynamics in patients in whom concrements were located in the intrarenal pelvis, which was due to the somewhat greater damage from the shock wave to the renal parenchyma, as compared to the mixed or ampullary pelvic types. We found that, when pyeloectasia persisted following stone destruction by extracorporal shock-wave nephrolithotripsy, renal hemodynamics deteriorated considerably in all patients independently of their calicopelvic system anatomy.
Renal blood flow is generally improved when adequate evacuation of urine from the renal pelvis and recovered tone of the calicopelvic system are achieved, which is feasible with the use of the Fizomed (Nephromed) belt. This appliance allows to significantly cut down on the use of invasive techniques employed to drain the upper urinary tract, such as ureteral catheterization, placement of internal and external stents, as well as transdermal nephrostomy. Considering our own experience, study evidence, and the information on the mechanism of action of the Fizomed (Nephromed) belt, we believe that its use makes sense not only in urolithiasis and chronic pyelonephritis, but also in cystitis and chronic prostatitis, because reflex innervation of these organs involves, apart from the sacral centres, the same spinal centres that are responsible for the reflex neural connection with the kidney.
E. N. Sitdykov,
Academician of the Academy of Sciences of the Republic of Tatarstan,
Professor, Chair of Urology, KazanStateMedicalUniversity.