Fizomed (Nephromed) belt – an effective way to treat urolithiasis
“Meditsinskaya Gazeta”, №84, 1 November 2000.
The high prevalence rates of urolithiasis, its increasing morbidity, poor results of applied surgical approaches, frequent relapses, and low efficacy of conservative treatment warrant the search for novel treatment modalities. One of the sparing therapies is the use of the Fizomed (Nephromed) belt. For correct application of this belt in medical practice, one has to clearly understand and interpret precisely the clinical aspects of the therapeutic process.
Indications for application of the Fizomed (Nephromed) belt include treatment of urolithiasis, prophylaxis of urolithiasis, before and after extracorporal shock-wave lithotripsy, and osteochondrosis of the lumbar spine.
The method of application is simple: the belt is wrapped around the small of the back with its paraffin inserts right over the kidneys; the belt is worn loosely. The correct size is chosen according to the waist circumference. The Fizomed (Nephromed) belt is an appliance of continuous use. The patient has to have it on round the clock, including in the night. This is the only way to achieve optimal efficacy.
The duration of treatment is absolutely individual. The minimal treatment duration, when the calculi are small, the kidney function is good, and there are no other urodynamic disturbances, ranges between one and three months. If the condition is long-standing or the patient has multiple concrements, calculi in both kidneys, or a history of kidney surgery, treatment may be required for as long as 6 – 9 months. The presence of dendritic calculi necessitates still longer duration of treatment. Our data show that such patients will benefit from continuous 12-month belt use. Clinical studies of the Fizomed (Nephromed) belt have confirmed its high efficacy and ultimate safety.
To allow appropriate control of the process of treatment, a urinalysis has to be obtained before the start of treatment so that inflammation in the urinary system and the presence of salts can be diagnosed. If chronic pyelonephritis in the active inflammation stage is diagnosed, a course of antibacterial and uroseptic therapy has to be administered. Chronic pyelonephritis is not a contraindication for application of the Fizomed (Nephromed) belt, but it always requires pharmaceutical correction.
Application of the Fizomed (Nephromed) belt can be easily combined with any medicines. In the process of treatment, urine analyses have to be obtained at least once every month, so that an exacerbation of chronic pyelonephritis is not missed and salt passage is followed.
The start-up clinical evaluation should include ultrasonography of the kidneys performed on a device with good resolution. If indicated, a plain X-ray film is obtained and / or excretory urography carried out.
In the course of treatment, after 2 – 4 weeks of belt use, another urine sample has to be obtained for urinalysis, after which follow-up urine tests for salts and gravel have to be carried out at least once every month. In one month after the start of treatment, follow-up kidney ultrasonography is appropriate, so that the structures of the calculi, their dimensions, and shapes can be assessed repeatedly. Our results demonstrate that round-the-clock use of the belt during one month results in changes in the concrement texture and its echogenicity as evidenced by ultrasound examination of the kidneys. The next kidney ultrasonography is recommended for 3 months of treatment. The decision to stop using the belt has to be taken only after the calculi have been destroyed completely and the gravel has been passed with urine. To confirm the positive outcome, follow-up kidney ultrasonography has to be performed once again.
There are no contraindications for the use of the Fizomed (Nephromed) belt.
Our belt use results obtained in a considerable number of patients imply that they generally tolerate the process of treatment well, but minor wearing inconveniences may be observed immediately after the start of treatment. The inserts will then gradually change in shape, and the process of treatment will become more comfortable.
In patients wearing the Fizomed (Nephromed) belt, the active inserts act so that the calculus is destroyed gradually and sheds gravel from the outside. The action of the belt affects all types of stones, independently of their chemical composition.
Treatment process variants
If the patient experiences low back pain, it is generally alleviated or completely eliminated in 14-25 days. After about 30-60 days from the start of treatment (depending on the patient’s individual features), renal stones start to “shatter” and pass with the urine flow as renal sand and tiny fragments. In some patients, this process is accompanied by dull pain in the small of the back and / or inguinal region, as well as along the course of the ureter; this pain does not necessitate discontinuation of the treatment. In this phase, the patient has to take analgesic or spasmolytic agents if the ache is pronounced.
In other patients, the process of passage of renal sand and concrement microfragments will not cause any painful sensations, which is not an indication of lacking therapeutic action. In rare cases, larger stone fragments may be passed, which is accompanied by renal colic symptoms. Adequate and timely treatment will allow to relieve the patient’s condition considerably.
If the calculus is dendritic (coral) or large, the belt wearing period is extended significantly and may take as long as one year. Gravel may start to pass in 2 or 3 months. Destruction of a coral stone is the most common cause of severe pain (ache); in this case, blood appears in passed urine, arterial pressure may be elevated; later, dull pain in the inguinal region and along the course of the ureter develop. At this time, it is especially important to correctly choose medicines and provide the patient with timely medical assistance.
In rare cases, backache or inguinal pain may debut on the first day of belt wearing. The patient’s condition can be significantly alleviated at this time by administration of spasmolytic drugs at conventional doses.
Urine changes in patients wearing the Fizomed (Nephromed) belt
In the course of treatment, urine changes its colour in many patients. Urine also becomes thick; a lot of flakes, salt, and gravel can be observed in it. Times to urine changes vary between individuals. These changes may be observed almost immediately after the start of belt wearing. In some cases, they may take 2 – 3 weeks or one month of belt use. Sometimes the changes will occur much later. Sometimes they are not visible and can only be identified on laboratory testing. One has to realize clearly that the process of treatment will have individual features in every particular patient.
Spicy and salty food, as well as exposure to cold, are better avoided during the treatment phase. When urine sand starts to pass, increased fluid intake should be recommended for the patient to make salt and sand passage easy – if there are no contraindications for this.
Belt use before and after extracorporal shock-wave lithotripsy
Analysis of results obtained in patients wearing the Fizomed (Nephromed) belt before and after extracorporal shock-wave lithotripsy obviously demonstrates that passage of stone microfragments in such patients is more intensive and less painful, while the period of concrement passage tends to shorten significantly. The Fizomed (Nephromed) belt should be worn until the gravel and salts are completely eliminated, which would be confirmed on follow-up kidney ultrasonography.
Prevention of urolithiasis
After the treatment course is complete and the improvement has been achieved, the patient can be advised to wear the belt for prevention. In this case, the belt should be on for at least 2 or 3 weeks every 2 or 3 months, until the belt’s expiry date arrives. If the patient wishes so, the belt should be worn at all times, without interruption. This well help get rid of the sand and salts, and prevent further stone formation.
The clinical experience gained with the Fizomed (Nephromed) belt has confirmed its evident advantages over other conservative options employed in the treatment of urolithiasis. Indeed, the Fizomed (Nephromed) belt destroys concrements of any type and heals both kidneys simultaneously; it is simple to use and provides high therapeutic efficacy at any disease stage. Furthermore, the belt presents a good tool of prevention, it has no contraindications for use and does not traumatize the patient.
All of the above allows us to recommend the Fizomed (Nephromed) belt for wider application in urologist practices in district polyclinics. The belt can be used in the treatment of urolithiasis both as monotherapy and in combination with other therapies.
V. PAVLOV, MD
Highest Category Urologist, 25 years of professional experience,
N. UVAROVA, MD
Highest Category Urologist, 23 years of professional experience