Persistent dysuria in women: etiological diagnostics and treatment

INTRODUCTION:Dysuria is a painful urination combined with its frequency and/or difficulty. Dysuria is observed in many urological diseases and is one of the most common reasons for treatment for urological cause. AIM:The aim of the study is to identify the etiological factors of dysuria in women and to evaluate a personalized approach to their treatment. MATERIALS AND METHODS:We analyzed the data of 368 women with chronical cystitis. The inclusion criteria for the study were the presence of dysuria (painful and frequent urination more than 8 times a day with or without difficulty), the prescription of urination disorders over one year old and age 18 and over. All patients underwent a comprehensive urological examination to identify the causes of urinary disorders. RESULTS:The Bacterial cystitis was confirmed only in 78 (21.2%) patients among all 368 women. In the remaining 290 (78.8%) patients, the causes of persistent dysuria were other diseases: bladder leukoplakia in 154 (41.8%), bladder pain syndrome/interstitial cystitis in 38 (10.3%), viral cystitis in 34 (9.3%), paraurethral formations in 29 (7.9%), neurogenic urinary dysfunction bladder in 25 (6.8%), urethral pain syndrome in 5 (1.4%) patients. Dysuria was also caused by postradiation cystitis (2 patients), secondary stones in the urinary bladder (2 patients), and one patient had extragenital endometriosis. CONCLUSIONS:The variety of reasons for the development of persistent dysuria in women requires careful examination of patients. Treatment should be carried out only after accurate verification of the diagnosis.

Objectification of the evaluation of a pharmacological test with alpha-adrenergic blocking agents during uroflowmetry

The tactics of treating dysuric disorders are largely determined by the pathophysiological and morpho-clinical basis: infravesical obstruction, impaired bladder contractility, complex neurogenic urination disorders, etc. Among the diseases that most often cause infravesical obstruction in men, the most common pathologies are benign prostatic hyperplasia, prostate cancer, prostate sclerosis, obstructive processes of the bladder neck (contractures, fibrosis), urethral strictures of various etiologies. The use of a comprehensive urodynamic study makes it possible to differentiate the causes of urinary disorders. One of the most common and non-invasive methods used in the urologist’s clinical practice is uroflowmetry. The use of the fuzzy logic algorithm described in the article for making a decision on the presence of obstructive urination allows one to assess the urodynamic situation using the home uroflow monitoring technique. Analytical urodynamics in conjunction with the fuzzy logic block increases the accuracy of describing the examination results, and the introduction of the proposed model into the software simplifies the work with diagnostic urological equipment and increases the efficiency of the examination.

Monitoring bladder filling in patients with neurogenic urination disorders: the role of wearable hardware and software systems

Introduction. The use of wearable hardware and software systems to control bladder filling is considered one of the most important technologies for remote monitoring in patients with neurogenic urinary disorders. Materials and methods. A search, analysis and systematization of literature was carried out in the PubMed, e-library and Google Scholar databases using the keywords neurogenic urination disorders , neurogenic bladder , ultrasound diagnostics , ultrasound examination , monitoring , monitoring – total 211 sources, from which 46 were selected for writing the article. Theses and their abstracts, as well as conference abstracts were excluded from the analysis. Results. Ultrasound monitoring and bioimpedansometry, or a combination of both, allows for a non-invasive assessment of bladder volume, and the use of modern technologies, such as wireless communications and smartphone applications, allows the patient to maximize the individualization of the bladder emptying rhythm. Complicating moments in the use of these technologies are the conservatism of doctors, patient compliance, the lack of methodological developments and recommendations for the use of these monitoring technologies. Discussion. The monitoring of bladder filling allows to avoid unnecessary catheterizations reducing the risk of urinary tract infections. Also it allows forming a wake-up reflex in a child with enuresis when he or she feels an urge to urinate. These technologies are currently considered experimental. Additional research is required before introducing them into clinical practice. Conclusions. The use of wearable hardware and software systems for monitoring bladder filling and special applications in smartphones in patients with neurogenic urinary disorders is an important step in finding solutions for each individual patient. Clinical monitoring studies are needed in routine urological practice.

Rehabilitation methods for patients with severe extragenital pathology after reconstructive plastic surgery for various types of urinary incontinence

In recent years, the frequency of operations for genital prolapse and urinary incontinence has been steadily increasing. Neurogenic disorders of urination can be the first manifestations of the disease of extragenital pathology. Neurogenic bladder is bladder dysfunction (lethargy or spasticity) caused by neurogenic damage. Any disease in which the afferent or efferent innervation of the bladder is damaged can lead to a neurogenic bladder.Purpose. To study the features of urinary disorders in women with severe extragenital diseases and to improve the methods of rehabilitation of patients after reconstructive plastic surgery for various types of urinary incontinence.Materials and methods. 153 patients aged 50-70 years (mean age 55.1 ± 6.3 years) and duration of postmenopause from 2 to 5 years (7.6 ± 4.1 years) were examined at the outpatient department of the of Moscow Regional Research Institute of Obstetrics and Gynecology, Russian Federation, who applied for various manifestations of urination disorders. All patients were offered the method of biofeedback in combination with electrical stimulation of the pelvic floor muscles as a treatment. When overactive detrusor therapy was detected, therapy was combined with medicamentous (solifenacin 5 mg [Vesicar] or myrobegron 50 mg [Betmiga] in the morning) in combination with estriol (cream or suppositories) 0.5 mg intravaginally 2 times a week. In the presence of symptoms of climacteric syndrome in the absence of contraindications, menopausal hormonal therapy was prescribed.Results. Subjectively, 150 (98.1 %) patients noted an improvement in their condition, 3 (1.9 %) patients did not notice the effect of treatment. The results showed a significant improvement in all OABSS and bladder diary scores, including frequency of urination during the day and at night, urgency and number of urge incontinence episodes, and urine volume. Analysis of the -hour pad test showed that the volume of urine lost, which averaged 16.5 g before treatment, was negative after treatment in patients who noted the effect. In 2 patients who did not notice the effect, no changes were found. Investigation of the intraurethral pressure profile in 23 (17.6 %) women before treatment revealed insufficiency of the internal sphincter of the urethra, leading to urinary incontinence during stress. After treatment, in 19 (82.6 %) patients, the insufficiency of the internal sphincter was not determined. In 3 (13.0 %) patients, intraurethral pressure remained in the range of 60 to 80 cm of water column and did not lead to urinary incontinence during stress. In 1 (4.3 %) patient, the insufficiency of the urethral closure persisted, which required repeated surgery.Conclusions. In patients with severe extragenital diseases against the background of vulvovaginal atrophy, an overactive bladder and a mixed form of urinary incontinence prevail. Extragenital pathology of various origins, especially concerning various parts of the central nervous system, obesity and diabetes significantly worsens the course of urination disorders in both conservative and surgical and combined treatment and requires additional treatment methods: pelvic floor muscle training, biofeedback therapy in combination with electrical stimulation of the pelvic floor muscles, local hormonal therapy, the use of M-anticholinergics, B-adrenomimetics.

Case Report: Emphysematous Cystitis and Pyelonephritis Induced by Uterine Prolapse in a Subject With Untreated Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is often accompanied by a lot of complications due to chronic hyperglycemia and inflammation. Emphysematous cystitis and pyelonephritis are rare types of urinary tract infections and are often complicated with DM. Herein, we report a case of emphysematous cystitis and pyelonephritis complicated with untreated DM. In addition, this case was very rare and interesting in that her emphysematous cystitis and pyelonephritis were induced by severe uterine prolapse, obstructive uropathy and urination disorders. Both uterine prolapse and DM should be appropriately treated because both can lead to the development of emphysematous cystitis and pyelonephritis.

LOWER URINARY TRACT SYNDROME IN ELDERLY AND SENILE PEOPLE WITH COMBINED PATHOLOGY OF THE PROSTATE AND LUMBAR SPINE

Для определения места и роли дегенеративных изменений поясничного отдела позвоночника в патогенезе синдрома нижних мочевых путей и успешности проведения лечебных мер наблюдали 106 мужчин пожилого и старческого возраста, страдающих доброкачественной гиперплазией предстательной железы и патологией позвоночника. Длительные хронические боли в пояснице испытывали 48 (45,3 %) пациентов, у 93,8 % из них отмечали никтурию, у 75 % - затруднения при мочеиспускании, у 60,4 % - ложные позывы на мочеиспускание, что мотивировало обращение к урологу. Выявленные с помощью опросника IPSS различия, соответственно 21,78±4,33 и 16,33±4,61 балла, указывали на негативное значение хронического болевого синдрома в формировании общей клинической картины урологической патологии. У лиц старческого возраста болевой синдром и симптомы раздражения мочевых путей были менее выраженными, чем у лиц пожилого возраста, а обструктивные симптомы, наоборот, более отчетливыми. Хронические болевые синдромы в поясничной области значительно чаще ( р <0,001)регистрировали у 67 пациентов с удовлетворительными и неудовлетворительными результатами лечения по поводу расстройств мочеиспускания, чем у 39 с наилучшей эффективностью. Таким образом, патология поясничного отдела позвоночника и связанные с ней хронические болевые синдромы вносят существенный вклад в патогенез и клиническую картину синдрома нижних мочевых путей и в результативность лечения расстройств мочеиспускания. Выявленные особенности следует учитывать в процессе диагностики и лечения комбинированной патологии. In order to determine the place and role of degenerative changes in the lumbar spine in the pathogenesis of lower urinary tract syndrome and the success of treatment measures, 106 elderly and senile male patients suffering from benign prostatic hyperplasia and spinal pathology were observed. Long-term chronic lower back pain was experienced by 48 (45,3 %) patients, 93,8 % of them had night urination, 75 % had difficulty urinating, and 60,4 % had false urge to urinate, which motivated them to contact a urologist.The differences identified using the IPSS questionnaire, respectively 21,78±4,33 and 16,33±4,61 points, indicated a negative value of chronic pain syndrome in the formation of the overall clinical picture of urological pathology. Among the senile patients, pain and urinary tract irritation symptoms were less pronounced than among the elderly patients, and obstructive symptoms, on the contrary, were more pronounced. Chronic pain syndromes in the lumbar region were significantly more frequent ( p <0,001) among 67 patients with satisfactory and unsatisfactory results of treatment for urination disorders than among 39 with the best efficiency. Thus, the pathology of the lumbar spine and associated chronic pain syndromes make a significant contribution to the pathogenesis and clinical picture of the lower urinary tract syndrome and to the effectiveness of treatment of urination disorders. The identified features should be taken into account in the process of diagnosis and treatment of combined pathology.

Erectile dysfunction cause in men with urination disorders

Introduction. Erectile dysfunction is an urgent problem of modern urology. There is a consistent correlation between the sexual dysfunction incidence and the aging changes in the man’s body. In this study, an attempt was made to analyze the causes of the discussed correlation. An analysis comparing the data obtained with the worldwide figures and the results previously reported in Russia was performed. Materials and methods. The prospective multicenter epidemiological study was carried out using the data acquired from April 1 to May 31, 2017 during the anonymous questioning of 525 men (average age 64.2±9.93) living in Moscow, who had contacted the urologist due to urination disorders. The respondents answered the questions of the specially developed 140-point questionnaire. All demographic and medical data was taken into account, including information on comorbidities and age of onset. The IIEF, IPSS, QoL and AMS (Aging Male Screening) questionnaires were completed. Statistical processing of the results was carried out. Results. Complaints of sexual dysfunction are a relatively rare reason for the urologist’s consultation in men with LUTS living in the Moscow region. However, the survey has revealed that 39.9% of men did not consider themselves sexually active. The particularly low sexual health rate was detected in the age group over 70. The average IIEF questionnaire score for the respondents was 39.40±21.14. Less than a third of respondents reported their sexual life quality as acceptable. The correlation coefficient between the total IIEF score and the birth year was +0.422, and for the IPSS score it was -0.205. Correlations were considered significant when p<0.001. The erectile dysfunction risk increases with age, however, according to numerous publications it is not due to natural aging process, but due to severe comorbidities, particularly hypertension, infections, vascular diseases and diabetes mellitus. The patients' compliance with healthy lifestyle, abstention from smoking and regular drinking, is of great importance. In this study, the 152 of 525 (29%) respondents were smokers at the time of the survey. Strong liquor was routinely consumed by 250 respondents (47.6%), and low-alcohol beverages were consumed by 167 people (31.8%). The onset of the listed above comorbidities occurs at the age of 50–60, which makes it possible to explain the rapid ED incidence increase in the corresponding age group. The pattern identified constitutes evidence of the organic causes of erectile dysfunction. Conclusion. Analysis of the erectile dysfunction type and incidence in patients with LUTS living in the Moscow region demonstrated certain differences between the results obtained and the results of similar American and European studies. A steady trend of sexual health deterioration was observed in patients aged over 55–65. We have proved correlation between these changes and various cardiovascular diseases manifestations (CAD, hypertension), the peak period of which falls on the described age group. Comparison of the data obtained to those of 2012 has demonstrated increased severity of the “age-related” symptoms.

Place of neurourology in the clinical neurology system. Neurourological rehabilitation

Disorders of urination of an obstructive and irritative nature are found in almost all major diseases of the nervous system and their symptoms are largely reminiscent of dysuric disorders in the local pathology of the urethra and bladder. Proper diagnosis and timely treatment determine not only the quality of life, but sometimes the very life of patients. Only the combined efforts of neurologists and urologists in the framework of the clinical direction "Neurouroscience" allows us to timely diagnose the cause of urination disorders and carry out the necessary treatment and rehabilitation measures.