Физиологические основы литокинетической терапии


В.В. Дутов, Д.М. Попов, А.А. Подойницын, А.А. Румянцев, С.Ю. Буймистр, В.И. Бондаренко, В.С. Гончарук, М.Т.С. Дадашов

1) ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»; Москва, Россия 2) МУ «ГКБ г. Жуковский»; Московская область, Россия
Одной из проблем в лечении мочекаменной болезни (МКБ) остается консервативное лечение камней мочеточника. Несмотря на развитие и совершенствование медицинского инструментария и методик оперативного удаления камней, применение консервативного воздействия, направленного на обеспечение самостоятельного отхождения камней и их фрагментов из верхних мочевыводящих путей (ВМП), не утратило своего значения. Желание ускорить процесс отхождения камней привело к широкому распространению разнообразных физиотерапевтических процедур. По мере накопления знаний о молекулярно-биохимических особенностях физиологии гладкомышечных клеток мочеточника и развития фармакологической науки растет интерес к возможности целенаправленного применения медикаментозных средств, воздействие которых могло бы существенно ускорить процесс самостоятельного отхождения конкрементов.

Литература


  1. Борисов И.А., Сура В.В. Современные подходы к лечению пиелонефрита. Тер. архив. 1982;7:125–135.
  2. Борисов В.В. Лучевые и уродинамические методы функциональной диагностики в урологической практике. Дисс. докт. мед. наук: М., 1999.
  3. Пытель Ю.А., Борисов В.В., Симонов В.А. Физиология человека. Мочевые пути. М., 1992. С. 145–156.
  4. Dellabella M., Milanese G., Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J. Urol. 2003;170:2202–2205. Doi: 10.1097/01.ju.0000096050.22281.a7
  5. Berridge M.J. Smooth muscle cell calcium activation mechanisms. J. Physiol. 2008;21:5047-5061. Doi: 10.1113/jphysiol.2008.160440
  6. Coll D.M., Varanelli M.J., Smith R.C. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR. 2002;178:101–103. Doi: 10.2214/ajr.178.1.1780101
  7. Lang R.J., Tonta M.A., Zolotkowski B.Z., et al. Pyeloureteric peristalsis: role of atypical smooth muscle cells and interstitial cells of Cajal-like cells as pacemakers. J. Physiol. 2006;576:695–705. Doi: 10.1113/jphysiol.2006.116855
  8. Laird J.M., Roza C., Cervero F. Effects of artificial calculosis on rat ureter motility: Peripheral contribution to the pain of ureteric colic. Am. J. Physiol. 1997;272:1409–1412.
  9. Lammers W., Ahmad H.R., Arafat K. Spinal and temporal variations in pacemaking and conduction in the isolated renal pelvis. Am. J. Physiol. 1996;270:567–574.
  10. Lang R.J., Hashitani H., Keller S., et al. Modulators of internal Ca2+ stores and the spontaneous electrical and contractile activity of the guinea pig renal pelvis. Br. J. Pharmacol. 2002;135:1363–1366. Doi: 10.1038/sj.bjp.0704609
  11. Lang R.J., Hashitani H., Tonta M.A., Parkington H.C., Suzuki H. Spontaneous electrical and Ca2+ signals in typical and atypical smooth muscle cells and interstitial cell of Cajal-like cells of mouse renal pelvis. J. Physiol. 2007;583:1049–1068. Doi: 10.1113/jphysiol.2007.137034
  12. McHale N.G., Hollywood M.A., Sergeant G.P., Shafei M., Thornbury K.T., Ward S.M. Organization and function of ICC in the urinary tract. J. Physiol. 2006;576(3):689–694. Doi: 10.1113/jphysiol.2006.116657
  13. Пытель Ю.А., Золотарев И.И. Ошибки и осложнения при рентгенологическом исследовании почек и мочевых путей. М., 1987. 256 с.
  14. Varanelli M.J., Coll D.M., Levine J.A., Rosenfeld A.T., Smith R.C. Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT. Am. J. Roent. 2001;177:325–330.
  15. Boyarsky S., et al. Urodinamic concepts. In: Urodinamic upper and lower urinary tract. Ed. by W. Lutzeyer, H. Melchiol. 1973. P. 1–13.
  16. Burnstock B. Structure of smooth muscle and its innervation. In: Bülbring E., Brading A.F., Jones A.W., Tomita T. (ed.) Smooth Muscle. Baltimore: Williams &Wilkins. 1970:1–69.
  17. Roberts J.A. Experimental pyelonephritis in the monkey. III. Pathophysiology of ureteral malfunction induced by bacteria. Invest. Urol. 1975;13:117–123.
  18. Stenberg Olsen P.R., Engstrand A., Perrson A.E.G. Pressure and flow measurement in the partion obstructed ureter. Scand. J. Urol. Nephrol. 1988;22:279–281.
  19. Kирпатовский В.И., Мудрая И.С. Варианты нарушений функции верхних мочевых путей при мочекаменной болезни. Урология. 1998;3:21–25.
  20. Gratzke C., Eckert S., Reich O., et al. PDE-5-Inhibitoren: Ein neuer Therapieansatz in der Behandlung der Harnleiterkolik? Der Urol. 2007;46:1219–1223. Doi: 10.1007/s00120-007-1409-3
  21. Fung Y.C. Peristaltic pumping: A bioengineering model. In: Boyarsky S., Gottschalk C.W., Tanagho E.A., Zimskind P.D., ed. Urodynamics. New York. Academic Press. 1971. P. 177–198.
  22. Wanajo I., Tomiyama Y., Tadachi M., Kobayashi M., Yamazaki Y., Kojima M., Shibata N. The potency of KUL-7211, a selective ureteral relaxant, in isolated canine ureter: comparison with various spasmolytics. Urol. Res. 2005;33(6):409–414. Doi: 10.1007/s00240-005-0475-5
  23. Мудрая И.С. Функциональное состояние верхних мочевых путей при урологических заболеваниях. Дисс. докт. мед. наук. М., 2002.
  24. Roberts J.A. Experimental pyelonephritis in the monkey. III. Pathophysiology of ureteral malfunction induced by bacteria. Invest. Urol. 1975;13:117–123.
  25. McGuire E.J. Physiology of the lower urinary tract. Am. J. Kidney Dis. 1983;2:402–407.
  26. Joseph E. Epidemiology and Incidence of Stone Disease. In: Urinary Stone Disease. Ed. by L. M. Stoller, M.M. Meng. 2007. P. 27–35.
  27. Gravina G.L., Costa A.M., Ronchi P. Tamsulosin treatment increases clinical success rate of single extracorporeal shock wave lithotripsy of renal stones. Urol. 2005;66:24–28. Doi: 10.1016/j.urology.2005.01.013
  28. Struthers N.W. The role of manometry in the investigation of pelviureteral function. Br. J. Urol. 1969;41:129–132.
  29. Backlund L. Experimental studies on pressure and contractility in the ureter. Acta Physiol. Scand. 1963;1:1–86.
  30. Morita T., Ando M., Kihara K., Oshima H. Function and distribution of autonomic receptors in canine ureteral smooth muscle. Neurourol. Urodyn. 1994;13:315–318.
  31. Stamatelou K.K., Francis M.E., Jones C.A., Nyberg L.M. Jr, Curhan G.C. Time trends in reported prevalence of kidney stones in the United States:1976–1994. Kidney Int. 2003;63:1817–1823.
  32. Santis W.F., Sullivan M.P., Gobet R. Characterization of ureteral dysfunction in an experimental model of congenital bladder outlet obstruction. J. Urol. 2000;163:980–985.
  33. McGuire E.J., Woodside J.R., Borden T.A., Weiss R.M. Prognostic value of urodynamic testing in myelodysplastic patients. J. Urol. 1981;126:205–207.
  34. Weiss R.M., Bassett A.L., Hoffman B.F. Dynamic length-tension curves of cat ureter. Am. J. Physiol. 1972;222:388–396.
  35. Дзеранов Н.К., Кирпатовский В.И., Бешлиев Д.А., Москаленко С.А., Волков И.Н., Мудрая И.С. Влияние нарушений уродинамики и сократительной функции верхних мочевыводящих путей на отхождение фрагментов камней после дистанционной литотрипсии. Урология. 2001;2:6–9.
  36. Mohseni M.G., Hosseini S.R., Alizadeh F. Efficacy of terazosin as a facilitator agent for expulsion of the lower ureteral stones. Saudi Med. J. 2006;27:838–840.
  37. Edyvane K.A., Smet P.J., Trussell D.C. Patterns of neuronal colocalisation of tyrosine hydroxylase, neuropeptide Y, vasoactive intestinal polypeptide, calcitonin gene-related peptide and substance P in human ureter. J. Auton. Nerv. Syst. 1994;48:241–244.
  38. Wheeler M.A., Housman A., Cho Y.H., Weiss R.M. Age dependence of adenylate cyclase activity in guinea pig ureter homogenate. J. Pharmacol. Exp. Ther. 1986;239:99–101.
  39. Mortensen J., Djurhus J.G. Hydrodynamics of the normal multicalyceal pyeloureter in pigs. The pelvis pressure response to increasing flow rater, its normal ranges and intraindividual variations. J. Urol. 1985;133:704–706.
  40. Lojanapiwat B., Kochakarn W., Suparatchatpan N., Lertwuttichaikul K. Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study. J. Int. Med. Res. 2008;36:529–536. Doi: 10.1177/147323000803600318
  41. Taft H.P., Fronkinder J., Mortensen J., Djurhus J.G. Renal pelvic peristalsis in pigs during standartised flow rate variations. Urol. Int. 1986;41(4):292–298.
  42. Marshall S., Lyon R.P., Minkler D. Ureteral dilatation following use of oral contraceptives. JAMA. 1966;198:782–783.
  43. Biancani P., Hausman M., Weiss R.M. Effect of obstruction on ureteral circumferential force-length relations. Am. J. Physiol. 1982;243:204–209.
  44. Irving S.O., Calleja R., Lee F., Bullock K.N., Wraight P., Doble A. Is the conservative management of ureteric calculi of >4 mm safe? B. J. Urol. Int. 2000;85:637–640. Doi: 10.1046/j.1464-410x.2000.00563.x
  45. Tahara H. The three dimensional structure of the musculature and the nerve elements in the rabbit ureter. J. Anat. 1990;170:183–191.
  46. Wanajo I., Tomiyama Y., Yamazaki Y., Kojima M., Shibata N. Pharmacological characterization of beta-adrenoceptor subtypes mediating relaxation in porcine isolated ureteral smooth muscle. J. Urol. 2004;172(3):1155–1159. Doi: 10.1097/01.ju.0000133557.39515.b6
  47. Biancani P., Zabinski M.P., Weiss R.M. Time course of ureteral changes with acute and chronic obstruction. Am. J. Physiol. 1976;231:393–395.
  48. Engelstein D., Kahan E., Servadio C. Rowatinex for the treatment of ureterolithiasis. J. Urol. 1992;98(2):98–100.
  49. Weiss R.M., Biancani P., Zabinski M.P. Adrenergic control of ureteral tonus. Invest. Urol. 1974;12:30–35.
  50. Reid R.E., Herman R., Teng C. Attempts at altering ureteral activity in the unanesthetized, conditioned dog with commonly employed drugs. Invest. Urol. 1976;12:74–77.
  51. Biancani P., Zabinski M.P., Weiss R.M. Bidimensional deformation of acutely obstructed in vitro rabbit ureter. Am. J. Physiol. 1973;225:671–646.
  52. Morita T., Ando M., Kihara K., Oshima H. Function and distribution of autonomic receptors in canine ureteral smooth muscle. Neurourol. Urodyn. 1994;13:315–318.
  53. Sigman M., Laudone V., Jenkins A.D. Ureteral meatotomy as a treatment of steinstrasse following extracorporeal shock wave lithotripsy. J. Endourol. 1988;2:41–45.
  54. McLeod D.G., Reynolds D.G., Swan R.G. Adrenergic mechanisms in the canine ureter. Am. J. Physiol. 1973;224:1054–1049.
  55. Nakada S.Y., Jerde T.J., Jacobson L.M. Cyclooxygenase-2 expression is up-regulated in obstructed human ureter. J. Urol. 2002;168:1226–1229.
  56. Fasil Marickar Y.M., Salim A., Vijay A. Effect of Rowatinex on calculus clearance after extracorporeal shock wave lithotripsy. J. Urol. 2009;6(1):9–13.
  57. Hernández M., Prieto D., Orensanz L.M: Nitric oxide is involved in the nonadrenergic, non-cholinergic inhibitory neurotransmission of the pig intravesical ureter. Neurosci. Lett. 1995. P. 186–193.
  58. Healy K.A., Ogan K. Nonsurgical management of urolithiasis: an overview of expulsive therapy. J. Endourol. 2005;19:759–767. Doi: 10.1089/end.2005.19.759
  59. Poulakis V. Editorial Comment on: Cost-Effectiveness of Medical Expulsive Therapy Using Alpha-Blockers for the Treatmen of Distal Ureteral Stones. Eur. Urol. 2008;53:419–420. Doi: 10.1016/j.eururo.2007.09.013
  60. Davenport K., Timoney A.G., Keeley Jr.F.X. Effect of smooth muscle relaxant drugs on proximal human ureteric activity in vivo: a pilot study. Urol. Res. 2007;35:207–213. Doi: 10.1007/s00240-007-0100-x
  61. Maggi C.A., Meli A. The effect of nifedipine and verapamil on KCl-induced rhythmic contractions on guinea-pig ureter in vitro. Experientia. 1984;40:681–686.
  62. Minneman K.P. α1-Adrenergic receptor subtype, inositol phosphates and sources of cell calcium. Pharmacol. Rev. 1988;40:87–119.
  63. Thulesius O., Angelo-Khattar M., Sabha M. The effect of ureteral distension on peristalsis: Studies on human and sheep ureters. Urol. Res. 1989;17:385.
  64. Maggi C.A., Giuliani S., Santicioli P. Effect of the Ca2+-ATPase inhibitor, cyclopiazonic acid, on electromechanical coupling in the guinea-pig ureter. Br. J. Pharmacol. 1995;114:127–131.
  65. Miyatake R., Tomiyama Y., Murakami M., et al. Effects of isoproterenol and butylscopolamine on the friction between an artificial stone and the intraureteral wall in anesthetized rabbits. J. Urol. 2001;166:1083–1087.
  66. Romics I., Molnar D.L., Timberg G. The effect of drotaverine hydrochloride in acute colicky pain caused by renal and ureteric stones. BJU Int. 2003;92:92–96. Doi: 10.1046/j.1464-410x.2003.04262.x
  67. Somlyo A.P., Somlyo A.V. Signal transduction by G-proteins, rho-kinase and protein phosphatase to smooth muscle and non-muscle myosin II. J. Physiol. 2000;522:177–185. Doi: 10.1111/j.1469-7793.2000.t01-2-00177.x
  68. Kűhn R., Uckert S., Stief C.G., et al. Relaxation of human ureteral smooth muscle in vitro by modulation of cyclic nucleotide-dependent pathways. Urol. Res. 2000;28:110–115. Doi: 10.1007/s002400050147
  69. Rong W., Burnstock G. Activation of ureter nociceptors by exogenous and endogenous ATP in guinea pig. Neuropharmacol. 2004;47(7):1093–1101. Doi: 10.1016/j.neuropharm.2004.08.003
  70. Кирпатовский В.И., Мудрая И.С. Адренергическая регуляция сократительной функции мочеточников человека и собаки. Бюлл. эксперим. биол. мед. 1992;4:363–365.
  71. Dunn C.J., Matheson A., Faulds D.M. Tamsulosin: a review of its pharmacology and therapeutic efficacy in the management of lower urinary tract symptoms. Drugs Aging. 2002;19:135–161. Doi: 10.2165/00002512-200219020-00004
  72. Lang R.J., Tonta M.A., Zolotkowski B.Z., et al. Pyeloureteric peristalsis: role of atypical smooth muscle cells and interstitial cells of Cajal-like cells as pacemakers. J. Physiol. 2006;576:695–705. Doi: 10.1113/jphysiol.2006.116855
  73. Lojanapiwat B., Kochakarn W., Suparatchatpan N.., Lertwuttichaikul K. Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study. J. Int. Med. Res. 2008;36:529–536. Doi: 10.1177/147323000803600318
  74. McHale N.G., Hollywood M.A., Sergeant G.P., Shafei M., Thornbury K.T., Ward S.M. Organization and function of ICC in the urinary tract. J. Physiol. 2006;576(3):689–694. Doi: 10.1113/jphysiol.2006.116657
  75. Weinberg S.R. Ureteral function. I. Simultaneous monitoring of ureteral peristalsis. Invest. Urol. 1974;12:103–107.
  76. Griffiths D.J. The mechanics of urine transport in the upper urinary tract. 2. The discharge of the bolus into the bladder and dynamics at high rates of flow.Neurourol. Urodyn. 1983;2:167–177.
  77. Ammons W.S. Bowditch Lecture. Renal afferent inputs to ascending spinal pathways. Am. J. Physiol. 1992;262:165.
  78. Hua X.-Y., Theodorsson-Norheim E., Lundberg J.M., et al. Co-localization of tachykinins and calcitonin gene-related peptide in capsaicin-sensitive afferents in relation to motility effects on human ureter in vitro. Neuroscience. 1987;23:693–697.
  79. Hong Y.K., Jang W.K., Lee Y.K., Park D.S. Efficacy of a furosemide-based medical expulsive therapy with tamsulosin (plus) deflazacort for a symptomatic distal ureteral stone
  80. Maggi C.A., Giuliani S. Nonadrenergic noncholinergic excitatory innervation of the guinea-pig renal pelvis. Involvement of capsaicin-sensitive primary afferent neurons. J. Urol. 1992;141:1394–1397.
  81. Saita A., Bonaccorsi A., Marchese F., Condorelli S.V., Motta M. Our experience with nifedipine and prednisolone as expulsive therapy for ureteral stones. Urol. Int. 2004;72(1):43–45. Doi: 10.1159/000076591
  82. Bustamante S., Orensanz L.M., Barahona M.V. NK2 tachykinin receptors mediate contraction of the pig intravesical ureter: Tachykinin-induced enhancement of non-adrenergic non-cholinergic excitatory neurotransmission. Neurourol. Urodyn. 2001;20:297–301.
  83. Onur M.R., Cubuk M., Andic C., Kartal M., Arslan G. Role of resistive index in renal colic. Urol. Res. 2007;35:307–312. Doi: 10.1007/s00240-007-0116-2
  84. Rose J.G., Gillenwater J.Y. Pathophysiology of ureteral obstruction. Am. J. Physiol. 1973;225:830–835.
  85. Chuang Y.H., Chuang W.L., Huang S.P., Liu K.M., Huang C.H. The temporal relationship between the severity of hydroureter and the dynamic changes of obstructed ureters in a rat model. Br. J. Urol. 1995;76:303–310.


Об авторах / Для корреспонденции


Дутов Валерий Викторович – д.м.н., проф., заведующий кафедрой урологии ФУВ, главный научный сотрудник ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия. Е-mail: valeriy.dutov.52@mail.ru, тел. +7 (495) 681-09-15;
Попов Дмитрий Михайлович – к.м.н., врач урологического отделения МУ «ГКБ г. Жуковский»; Москва, Россия. Е-mail: surgeon67@yandex.ru, тел. +7(926)319-37-79
Румянцев Андрей Александрович – к.м.н., зав. урологическим отделением МУ «ГКБ г. Жуковский», доцент кафедры урологии ФУВ ГБУЗ «МОНИКИ им. М.Ф. Вла-димирского»; Москва, Россия. Е-mail: rumyancevuro@mail
Подойницын Алексей Алексеевич – к.м.н., ассистент кафедры урологии ФУВ, зам. главного врача ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия. Е-mail: a9251252261@gmail.com
Буймистр Светлана Юрьевна – аспирант кафедры урологии ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия. Е-mail: svetlanabuymistr@mail.ru
Бондаренко Вячеслав Игоревич – аспирант кафедры урологии ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия. Е-mail: iprists@gmail.com
Гончарук Виталий Станиславович – аспирант кафедры урологии ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия. Е-mail: goncharuk.vitalii@inbox.ru,
тел. +7(926)363-75-89.
Дадашов Магамед Таги Сулейманович – клинический ординатор кафедры урологии ФУВ ГБУЗ «МОНИКИ им. М.Ф. Владимирского»; Москва, Россия.
Е-mail: tagidadashov@gmail.com тел. +7(926) 170-57-97.


Похожие статьи


Бионика Медиа