Vascular effects of combined vacuum interferential therapy in patients with urolithiasis after extracorporeal shock wave lithotripsy

Abstract

To study the combined vacuum-interference therapy effect on the renal blood flow in patients with urolithiasis after ECSWL. Forty patients aged 33 to 64 years old with urolithiasis after ECSWL were included in the study. Patients were assigned into two groups by simple randomization. Starting the second day after ECSWL, along with drug therapy, the patients of the main group (n=20) received vacuum-interference therapy with the carrier frequency of 5 kHz, frequency range 80-150 Hz, and the vacuum of 0.3-0.4 bar for 15 min daily, 6-8 procedures in total. Patients in the control group (n=20) received antibacterial and anti-inflammatory drug therapy, the same as the main group. To evaluate the severity of impaired renal blood flow due to nephrolithotripsy, we studied renal blood flow by the basic hemodynamic characteristics of renal ultrasound dopplerography (USDG): renal blood flow indices at the level of renal, segmental, interlobar, and arch arteries, including measurement of systolic linear blood flow velocity (Vps) and diastolic blood flow velocity (Vsd), as well as pulsatility index (PI) and resistance index (RI). The ultrasound examination prior to ECSWL revealed a statistically significant increase in all studied parameters. Thus, Vsd in renal arteries was increased by 32.7% (p<0.01) and 17.8% (p<0.05), respectively; in segmental arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively; in interlobar arteries by 14.5% (p<0.05) and 29.5% (p<0.05), respectively, and in the arcus arteriosus by 10.7% (p<0.05) and 21.4% (p<0.05), respectively; the renal vein blood flow was within the reference range. When assessing PI in UL patients before lithotripsy, a statistically significant increase in all studied indices was also observed: in the renal arteries by 19.0% (p<0.05), in the segmental arteries by 12.5% (p<0.05), and in the interlobar and arch arteries by 11.6% (p<0.05) and 11.8% (p<0.05), respectively. After the treatment course, the most pronounced change was observed in the patients of the main group, in which all indices differed from the reference values only by 3.5-8.3%. It is important to note an increase in linear velocity in the renal vein by 21.4% (p<0.05), indicating a significant improvement of renal blood flow due to improved venous outflow and increased arterial inflow in the renal arteries. In the control group patients, statistically significant improvement was observed only for systolic and diastolic blood flow velocity, as well as the renal vein blood flow velocity, which increased by 22.1% (p<0.05), 6.3% and 17.8% (p<0.05), respectively; the other parameters remained unchanged. When assessing PI and RI values after the treatment course, the most marked improvement was also observed in the main group of patients, in which all indices were close to the reference values (p<0.05). In the control group patients, the indices were 11.6-14.0% higher than reference values (p<0.05). According to obtained data, it was concluded that vacuum interference therapy has a pronounced vascular effect that promotes an earlier recovery of blood flow and normalization of the kidney function in patients with urolithiasis after extracorporeal lithotripsy and can be recommended for routine clinical practice.