rfhealthЗдравоохранение Российской ФедерацииHealth care of the Russian Federation0044-197X2412-0723Federal Scientific Center of Hygiene named after F.F. Erisman10.47470/0044-197X-2021-65-5-485-491rfhealth-607Research ArticleОБЗОРЫREVIEWSУродинамические исследования и особенности проведения анестезии при внутридетрузорной ботулинотерапии в условиях пандемии COVID-19 (обзор литературы)Urodynamic studies and features of anaesthesia during intradetrusor botulinum therapy in the context of the COVID-19 pandemic (literature review)https://orcid.org/0000-0002-9872-0959ЛысачевД. А.LysachevDmitriy A.noemail@neicon.ruhttps://orcid.org/0000-0002-0751-4982ХодыреваЛюбовь АлексеевнаKhodyrevaLyubov A.

Доктор мед. наук, профессор, зав. ОМО по урологии ГБУ НИИ ОЗММ ДЗМ, 115184, Москва.

e-mail: khodyreva60@mail.ru

Doctor Med. Sci., PhD, Professor, Head of the Urology department Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, 115184, Russian Federation.

e-mail: khodyreva60@mail.ru

khodyreva60@mail.ruhttps://orcid.org/0000-0002-5529-1787СтрогановР. В.StroganovRoman V.noemail@neicon.ruhttps://orcid.org/0000-0002-5807-7591КуприяновЮ. А.KupriyanovYuri A.noemail@neicon.ruФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава РоссииMoscow State University of Medicine and Dentistry named after A.I. EvdokimovГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare DepartmentГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы»; ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава РоссииResearch Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov202111112021655485491Copyright © Лысачев Д.А., Ходырева Л.А., Строганов Р.В., Куприянов Ю.А., 20212021Лысачев Д.А., Ходырева Л.А., Строганов Р.В., Куприянов Ю.А.Lysachev D.A., Khodyreva L.A., Stroganov R.V., Kupriyanov Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rfhealth.ru/jour/article/view/607

Пандемия коронавирусной инфекции оказывает серьёзное влияние на систему здравоохранения, вносит изменения в назначение и проведение диагностических процедур, оказание экстренной и плановой медицинской помощи.

Согласно медицинским рекомендациям Европейского общества урологов в сложившейся эпидемической обстановке установлены различные уровни ургентности для проведения диагностических и лечебных урологических мероприятий в зависимости от типа заболевания. Уродинамические исследования относятся к исследованиям с уровнем приоритета от P2 (при нейрогенных нарушениях функции мочевыделительных путей) до P4 (при дисфункции нижних мочевых путей без риска поражения верхних мочевых путей). Встаёт вопрос относительно безопасности проведения этих исследований в условиях вирусной пандемии как для пациентов, так и для медицинских сотрудников. 

Ввиду повышенной загруженности стационаров, не перепрофилированных под борьбу с коронавирусной инфекцией и оказывающих плановую и экстренную урологическую помощь, возникла ещё бóльшая необходимость в поиске эффективных и безопасных способов местной анестезии для выполнения уродинамических исследований и внутридетрузорных инъекций ботулинического токсина типа А под местной анестезией в амбулаторных и поликлинических условиях (например, в условиях стационара кратковременного пребывания).

В статье представлен обзор принципов и особенностей выполнения уродинамических исследований в условиях пандемии COVID-19, а также эффективности и безопасности применения различных методик местной анестезии при выполнении внутридетрузорных инъекций ботулинического токсина типа А пациентам с детрузорной гиперактивностью нейрогенной и ненейрогенной природы. Оценивали такие способы местной анестезии, как внутридетрузорная инстилляция лидокаина, электрофорез, использование альтернативных растворов (например, раствора Рингера) для орошения мочевого пузыря.

The coronavirus pandemic has had a severe impact on the health care system. It is also changing the appointment and conduct of diagnostic procedures, emergency and routine medical care. 

According to the medical guidelines of the European Society of Urology (EAU) for the provision of urological care during the current epidemic situation, various levels of urgency have been proposed for diagnostic and therapeutic measures depending on the type of disease. Urodynamic studies refer to studies with a priority level from P2 (for neurogenic dysfunction of the urinary tract) to P4 (for lower urinary tract dysfunction without the risk of damage to the upper urinary tract). The question arises regarding the safety of these studies, both for patients and medical staff, and possible measures to reduce the risk of infection in a viral pandemic. 

Because of the increased workload of hospitals that have not been redesigned for the fight against coronavirus infection and provide routine and emergency urological care, an even greater need has arisen to find effective and safe methods of local anaesthesia for performing urodynamic studies and intradetrusive injections of botulinum toxin type A under local anesthesia in outpatient and outpatient settings (for example, in a short-term hospital). 

This article presents a literature review on the principles and features of performing urodynamic studies in the context of the Covid-19 pandemic and the effectiveness and safety of using various methods of local anaesthesia when performing intradetrusor injections of botulinum toxin with detrusor hyperactivity of a neurogenic and non-neurogenic nature. There were evaluated forms of local anaesthesia such as intradetrusor instillation of lidocaine, electrophoresis, and the use of alternative solutions for urinary bladder irrigation (for example, Ringer’s solution).

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The authors declare that there are no conflicts of interest present.