Physiotherapy in the rehabilitation of patients with urolithiasis with ureteral stones after extracorporeal shock wave lithotripsy
Authors:   FSBSI Petrovsky National Research Centre of Surgery, Moscow, Yamenskov Vladimir Vladimirovich ,   Department of Vascular Surgery, FSBI Third Central Military Clinical Hospital named after A. A. Vishnevsky of the Ministry of Defense of the Russian Federation, Esipov Artem Aleksandrovich ,   FSBI Third Central Military Clinical Hospital named after A. A. Vishnevsky of the Ministry of Defense of the Russian Federation
Published: August 2022

Urolithiasis currently occupies a leading position among all urological pathologies, accounting for 26 % to 37 %, which elevates this problem to the rank of socially significant issues and determines the high relevance of finding new approaches to the development of rehabilitation programs to use in the early postoperative period after shock wave lithotripsy for the prevention of postoperative complications and relapses of the disease. Objective. To study the features of the influence of combined vacuum interferential therapy and mono-influences with interferential currents on nitrogen metabolism and excretory function of the kidneys in patients with urolithiasis with ureteral stones after extracorporeal shock wave lithotripsy. Material and methods of treatment. The study included 105 male patients with urolithiasis and ureteral stones after extracorporeal shock wave lithotripsy, whose mean age was 47.6 ± 3.8 years. The patients were divided by simple randomization into 3 groups comparable in terms of age, clinical and functional characteristics, and instrumental data: from the 2nd day after ESWL against the background of drug treatment, the patients of the main group 1 (n = 35) were prescribed vacuum interferential therapy on the lumbosacral region and the projection of the ureters with a carrier frequency of 5 kHz, in the frequency range of 80–150 Hz, with a vacuum of 0.3–0.4 bar, 15 min per unit, 6–8 procedures per course; from the 2nd day after ESWL against the background of drug treatment, the patients of the comparison group (n = 35) were prescribed mono-impacts of interferential currents on the lumbosacral region and the projection of the ureters with a carrier frequency of 5 kHz, in the frequency range of 80–150 Hz, 15 min per unit, 6–8 procedures per course; the patients in the control group (n = 35) were prescribed antibacterial and anti-inflammatory drug therapy, which served as a background in the main and the comparison groups. Research results. When studying the indicators of nitrogen metabolism in the blood in the initial state, an increase in the content of uric acid and creatinine was noted against the background of a decrease in the content of potassium. After the course of treatment, the most pronounced dynamics was revealed in the patients of the main group, which manifested in a significant decrease of creatinine by 15.2 % (p ˂ 0.05) and uric acid by 13.6 % (p ˂ 0.05) against the background of an 8 % increase in the content of potassium (р ˂ 0.05) in blood. Although the indicators of nitrogen metabolism improved under the influence of interferential therapy in the patients of the comparison group, the differences were not significant and were regarded only as a positive trend. Prior to the start of treatment, a decrease in pH, daily diuresis, glomerular filtration, and tubular reabsorption against the background of an increase in oxalate salts was found in daily urine. After the course of treatment, the patients in the comparison group received significant positive dynamics in all studied parameters, which manifested in an increase in pH, daily diuresis, glomerular filtration, and tubular reabsorption against the background of a decrease in the level of oxalate salts. In the control group, there was only a slight positive trend. Conclusion. Vacuum interferential therapy has an anti-inflammatory and diuretic effect to a greater extent than interferential therapy, contributing to the normalization of the excretory function of the kidneys and nitrogen metabolism in patients with urolithiasis with ureteral stones after ESWL, and can be recommended for use in wide clinical practice.