[Language, cultural adaptation and validation of the OABSS (Overactive Bladder Symptom Score) questionnaire in patients with overactive bladder].

AIM: To perform language and cultural adaptation and validation of the OABSS (Overactive Bladder Symptom Score) questionnaire among patients with overactive bladder (OAB), proposed as an effective tool for assessing the severity of symptoms and the efficiency of treatment in clinics of the Russian Federation. MATERIALS AND METHODS: In accordance with the protocols for carrying out such studies, the procedure of standardized forward-backward translation of the OABSS questionnaire was performed. Further, the intermediate Russian-language version was applied to 15 patients with subsequent correction of deficiencies and approval of the final Russian-language version of the questionnaire. In total, the study group included 176 patients of both sexes with OAB symptoms who filled out the questionnaire twice (test-retest) with an interval of 10-14 days. RESULTS: Based on the statistical analysis (Cronbach's alpha = 0.961), there was a significant degree of internal consistency of the sample. This fact is also supported by the very high retest reliability of the questionnaire (ICC >0.9). CONCLUSION: Our data showed that the Russian version of the OABSS questionnaire is a reliable and valid tool for subjective assessment of the severity of OAB symptoms.

[Long-term safety and efficacy of trospium chloride for the treatment of neurogenic overactive bladder due to Parkinson's disease is there an effect on cognitive status?]

AIM: To evaluate the efficiency of long-term use of trospium chloride (Spazmex) for the treatment of patients with neurogenic overactive bladder due to Parkinson's disease (PD) and to determine the influence of therapy on the cognitive status of patients. MATERIALS AND METHODS: 60 patients with PD and neurogenic overactive bladder with stages 2.5, 3 and 4 according to Hoehn-Yahr scale were included in the main group. The mean age was 58.2+/-5.7 years. All patients were prescribed trospium chloride at entry into the study, with doses titrated gradually according to clinical efficacy (30 to 90 mg). The comparison group included 15 patients with PD and neurogenic overactive bladder at stages 2,5 and 3, who received tibial neuromodulation according to the standard technique with skin electrodes. The mean age of patients was 56.4+/-4.6 years. At baseline, both groups were comparable in terms of gender, age and cognitive status (p=0.801). All patients received treatment for 52 weeks. The efficiency of therapy was assessed according to bladder diaries, while safety outcomes included postvoid residual, side effects, cognitive status according to the MoCA scale and quality of life according to the SF-Qualiveen questionnaire. RESULTS: clinical efficacy and satisfaction were achieved in all patients who completed the study (47 patients in the main group and 15 patients in the comparison group). Good clinical efficacy was demonstrated in both groups, since there was a decrease in the number of urinations, episodes of urgency and urinary incontinence. In addition, there was an improvement in the quality of life according to the SF-Qualiveen scale. The cognitive status during the entire follow-up period remained without significant changes in both groups. CONCLUSION: Trospium chloride is an effective drug in patients with PD. It does not affect cognitive functions during long-term use. Trospium chloride should be considered as first-line drug in those with urologic manifestations of PD.

[Neurogenic overactive bladder: focus on cognitive function].

BACKGROUND: An overactive bladder and cognitive impairment are two medical and social problems, which have an outmost importance, affecting the quality of life. Both disorders are common in the practice of a urologist, neurologist, internist, and other physicians. Parkinsons disease and multiple sclerosis are the most common neurological diseases, which often manifest by pelvic dysfunction and cognitive dysfunction. The clinician needs to understand the pathogenesis of the underlying disease and the pharmacologic properties of drugs, which can be used both in neurology and urology, as well as in other related specialties. AIM: To evaluate cognitive functions in patients with neurogenic overactive bladder treated with trospium chloride. MATERIALS AND METHODS: A total of 45 patients with neurological disease (28 with Parkinsons disease [group 1] and 17 with multiple sclerosis [group 2]) were included in the study. All patients had symptoms of an overactive bladder. Trospium chloride was administered in an individually adjusted dose for 12 weeks. Cognitive functions were assessed using the international Montreal Cognitive Assessment (MoCA) before and after the therapy. A change of total scores over time was assessed using the paired Wilcoxon test. The level of significance of <0.05 was used (confidence level of 95%). RESULTS: A significant decrease in all studied parameters of an overactive bladder in both groups was seen. The baseline evaluation of the total score on the MoCA scale prior to the start of taking trospium chloride revealed the presence of moderate cognitive impairment (21.3+/-2.9 points) in patients of the group 1. After 12 weeks of therapy, no significant change in cognitive functions was observed (21.7+/-3.1 points; p>0.05). In group 2, moderate cognitive impairment (MoCA 22.5+/-3.7 points) was found at baseline. After taking trospium chloride, no significant changes were noted (MoCA 22.9+/-4.1 points) (p>0.05). No central nervous system side effects were reported in any group. CONCLUSION: Trospium chloride is an effective drug, which does not affect cognitive functions in patients with neurogenic overactive bladder. This drug is safe to use in both Parkinsons disease and multiple sclerosis, considering the low risk of cognitive impairment in polypharmacy.

[The role of male factor in pregnancy loss].

Currently fertility specialists pay close attention to miscarriage. Spontaneous abortion and recurrent pregnancy loss in an early period of gestation are a frequent complication of pregnancy. Etiology of miscarriage includes genetic abnormalities, immunological disorders, endocrine abnormalities, infections and lifestyle factors. About 40% of cases of pregnancy losses remain unexplained. The role of male factor in miscarriages is considered in the review. The influence of advanced paternal ages, sperm DNA fragmentation, chromosomal abnormalities on pregnancy loss in natural conception or by assisted reproductive technique are described.

[New approach to the treatment of patients with overactive bladder. Mirabegron: past, present and future].

The prevalence rate of overactive bladder symptoms is 16% for men and 16.9% for women. Currently, m-anticholinergics are the first line of therapy. The selective and non-selective antimuscarinic drugs are available in Russian Federation. Some patients refuse long-term use of -anticholinergics due to either side effects, or insufficient efficacy. This situation prompted world scientific community to search of alternative treatment methods. Mirabegron is a selective 3-adrenoreceptors agonist, which represent a new approach to the treatment of patients with overactive bladder. In this article the studying of adrenoreceptors, properties of mirabegron and the possibilities for its applications are reviewed.

[PROSPECTS FOR THE TREATMENT OF IDIOPATHIC AND NEUROGENIC OVERACTIVE BLADDER].

Overactive bladder (OAB) is a common problem in modern population. The main line of medical treatment of this condition is the use of M-cholinoblockers. Solifenacin has shown high selectivity for the bladder in preclinical studies. Data on the efficacy and safety of high-dose (10 mg/day) of solifenacin are insufficient. The study was aimed to the comparative evaluation of the effectiveness and safety of solifenacin at a dose of 5 and 10 mg/day. The study included 28 patients (17 women and 11 men), mean age was 41.3±6.7 years. All patients were divided into two groups. In Group 1 included 12 patients with idiopathic overactive bladder, the Group 2 (n=16) - with neurogenic overactive bladder. Depending on the effect obtained, in some patients the dose was increased to 10 mg/day 1 month after starting treatment. The duration of treatment was 12 weeks. Application of solifenacin at a dose of 5 mg in patients with overactive bladder significantly reduces the severity of symptoms. Increasing the dose was required in 3 (25%) patients with idiopathic OAB and in 10 (62.5%) - with neurogenic OAB. Patients unsatisfied by therapy with solifenacin 5 mg/ day initially had more severe symptoms of the disease - significantly more urgency frequency, incontinence episodes, and nocturia. The use of high doses of solifenacin increased the effectiveness of treatment. Statistical significance was achieved for all parameters evaluated. Against the background of increasing doses, the number ofadverse effects may increase, but within a month of therapy in most cases they are reduced.

[Tibial neuromodulation in the treatment of neurogenic detrusor hyperactivity in patients with Parkinson's disease].

Twenty nine patients with neurogenic detrusor overactivity due to Parkinson's disease have undergone percutaneous tibial neuromodulation. The treatment consisted of percutaneous insertion of a 34-gauge solid stainless steel needle at a point of 5 cm cephald from the medial malleolus. The patients were treated weekly for 30 minutes. A subjective effect was assessed using a dairy and I-PSS score. Objective results were evaluated by cystometry. We observed a decrease in the average voiding frequency, number of leakage episodes after 12 sessions and 6 months of the tibial neuromodulation. An over 50% symptomatic improvement was achieved in 26 of 29 patients including 6 patients who were refractory to anticholinergic agents and 9 men with benign prostatic hyperplasia. Tibial neuromodulation is an effective treatment in patients with neurogenic detrusor overactivity due to Parkinson's disease.