[The study of diagnostic capabilities of somatosensory evoked potentials in patients with neurogenic urinary retention]. / Diagnosticheskie vozmozhnosti issledovaniia somatosensornykh vyzvannykh potentsialov u bol'nykh s neirogennoi zaderzhkoi mochi.

OBJECTIVE: To study diagnostic capabilities of somatosensory evoked potentials (SSEP) in clarifying the mechanisms of formation of urinary disorders. MATERIAL AND METHODS: The authors studied the characteristics of nerve impulses during stimulation of the pudendal and tibial nerves in patients with neurogenic urinary retention and cerebral ischemic stroke in the parietal lobes (4 patients), spinal ischemic stroke (10 patients), myelitis at the level of thoracic segments (7 patients), spinal cord cauda equina tumors (3 patients). RESULTS AND CONCLUSION: The study of SSEPs made it possible to determine the localization and nature of damage to the structures of the central nervous system and to establish the neurogenic cause of urinary disorders.

[Erectile dysfunction after nerve-sparing radical prostatectomy].

Nerve-sparing radical prostatectomy remains the optimal curative treatment of prostate cancer in patients who want to maintain erectile function. Since its development, there has been a gradual decline in its effectiveness concerning the prevention of ED, which was associated with the currently more objective assessment of erectile function at both the pre- and post-operative stage. There is a knowledge gap in the precise understanding of which specific neural structures should be preserved with the nerve-sparing technique. At the same time, there have been proposed effective methods for visualizing the elements of the preserved vascular-neural bundle and estimating the degree of nerve-sparing.

[The modern methods of the electrical stimulation for the management of neurogenic disturbances of urination].

The results of the present study provide materials for the characteristic and the comparative analysis of the methods for electrical stimulation applied for the treatment of neurogenic disorders of urination and illustrate the up-to-date requirements to this therapy taking into consideration the neuroanatomical and neurophysiological features of micturition. One of the most advanced non-pharmacological methods is electrical stimulation and neuromodulation of the urinary bladder function and pelvic floor muscles. The objective of this three-step research was to elucidate the mechanisms of action of electrical stimulation and to compare the effects of tibial and pudendal neuromodulation in 22 patients presenting with ischemic lesions in the brain. The first step included the comprehensive clinical and neuroimaging investigations designed to determine the role of functional asymmetry of cortical and subcortical micturition regulatory centers during the recovery process following the ischemic lesions. At the second stage, afferent and central regulation of micturition was investigated by the method of tibial and pudendal somatosensory evoked potentials in the patients presenting with overactive bladder and acute or chronic cerebral ischemia. At the final step, the optimal parameters of neuromodulation were chosen depending on the form of the urination disorder. It is concluded that the study gave evidence of the high therapeutic effectiveness of tibial and pudendal neuromodulation for the treatment of overactive bladder associated with neurological disorders (including ischemic lesions in the brain).

[Current pharmacotherapy of overactive bladder in neurological patients].

The literature data on the urgent neurological problem - overactive bladder (OAB) are summarized. The OAB prevalence, current conceptions on the physiology and pathophysiology of urination and pathogenetic mechanisms of OAB development are presented. Main groups of pharmacological agents used in OAB treatment are described. Special attention is drawn to rationale of using anticholinergic (antimuscarinic) drugs. The authors present the results of their own comparative analysis on the efficacy and tolerability of these drugs in treatment of patients with cerebral vascular diseases including the use of solifenacin succinate (VESIcare).

[Differential diagnosis and treatment of neurogenic and psychogenic dysuria in case of overactive bladder syndrome].

The diagnosis of neurogenic and psychogenic dysurias is the most difficult and controversial problem of modern urology, the solution of which requires a differentiated approach based on the comparison of neurological, psychic, and urologic symptoms. The basis for their diagnostic search is the method of substitution of found symptoms in the schemes of known urologic, neurological diseases and psychopathological states in the direction from the general to the particular, i.e. by the method of deductive reasoning. The results of diagnostic tests and pharmacological analysis only clarify the details of final diagnosis. When one patient has an organic lower urinary tract lesion concurrent with neurogenic dysuria is the most difficult diagnostic case. The diagnosis of such conditions necessitates the performance of ultrasound, neurophysiological, neuroimaging, and urodynamic studies. The neurogenic disorders are characterized by a concomitance of neurological and urologic symptoms that generally occur at the same time, by a change in urodynamic parameters, and by a positive effect of specific therapy encompassing anticholinergic, sympatholytic, and other neurotropic agents. Psychogenic dysurias are not attended by neurological deficit and the instrumentally signs of organic urinary tract lesion, but is always accompanied by the psychopathological symptoms of anxiety or depression. Moreover, there is a positive effect of psychotropic drugs (anxiolytics or antidepressants) and indifference to the use of neurourologic agents.

[Neurourological signs of chronic cerebral vascular diseases].

Disorders of urination, along with motor and cognitive disorders, are characteristic of different forms of chronic cerebral vascular diseases (CCVD). Irritation symptoms are more frequent in subcortical arteriosclerotic encephalopathy (SAE) and multi infarct hypertonic encephalopathy (MIHE). Overactive urine bladder syndrome (OUBS) caused by neurogenic detrusive hyperactivity manifests itself in frequent urination, nocturia and imperative enuresis and thus decreases quality of life and results in disability of patents with CCVD. At the same time, the character of symptoms points indirectly to the localization of lacunar infarction or the extent of severity of leukoareosis. It is the most frequent form of disorders of urination in the first years of disease that significantly aggravates its course and needs timed diagnosis and pharmacological treatment. Competitive antagonists of muscarinic receptors M2, M3 subtypes are the most effective drugs for treatment of OUBS comorbid to CCVD.

[Experience with application of trospium chloride in patients with neurogenic detrusor overactivity].

Overactive bladder (OAB) is observed in such brain diseases as stroke, hypoxic ischemic encephalopathy, Parkinson's disease (PD), multiple sclerosis (MS). Trospium chloride (spasmex) was used in OAB patients with MS (n = 87), stroke (n = 83), encephalopathy (n = 47) and PD (n = 36) in doses from 15 to 45 mg/day in 2 to 36 month courses. The response with minimal side effects was achieved in 94% patients. In addition to basic effects, trospium chloride relieved spastic constipation in patients with stroke, hypersalivation in PD and anal incontinence in MS.

[Afferent stimulation of the tibial nerve in patients with hyperactive bladder]. / Afferentnaia stimuliatsiia tibial'nogo nerva u bol'nykh s giperaktivnym mochevym puzyrem.

36 patients with overactive bladder (24 with idiopathic detrusor instability; 12 with detrusor hyperreflexia due to multiple sclerosis) underwent percutaneous afferent 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 12 weeks for 30 minutes. A subjective effect was assessed using a dairy. An objective effect was analysed by urodynamic studies. We noticed a decrease in the average voiding frequency, number of leakage episodes and pad use per 24 hours after 12 sessions of the stimulation. Symptomatic improvement of more than 50% was achieved in 28 of 36 patients. No significant adverse events related to the treatment were observed. Thus, stimulation of the posterior tibial nerve is effective in patients with overactive bladder.

[Acute urinary retention caused by urethral polyp]. / Polip uretry, vyzvavshii ostruiu zaderzhku mocheispuskaniia.

A polyp of the prostatic part of the urethra is a rare pathological finding. A 20-year-old male visited our clinic with acute urinary retention. Ultrasound investigation, x-ray and endoscopic examinations revealed a polyp of the prostatic urethra. The polyp was resected by Ho-YAG laser. The resection resolved the urinary retention. The histopathological diagnosis was fibroepithelial polyp.

[Tropacin in the treatment of patients with the hyperactive urinary bladder]. / Tropatsin v lechenii bol'nykh s giperaktivnym mochevym puzyrem.

AIM: To examine effectiveness and tolerance of tropacin in patients with hyperactive urinary bladder (HAUB). MATERIAL AND METHODS: 62 patients aged between 19 and 82 with hyperactive bladder have received tropacin in a dose 3-10 mg twice a day for 12 weeks. Of them 31 had idiopathic detrusor unstability (IDUS), 10 had sensory urgent disorders (SUD), 21 suffered from detrusor hyperreflexia (DHR). RESULTS: In IDUS patients 12-week tropacin administration reduced mean daily number of urination from 14.3 to 10.9, mean daily number of episodes of inperative enuresis diminished from 3.9 to 2.2. DHR patients showed the above decrease from 15.2 to 12.7 and 4.1 to 2.2, respectively. In sensory urgency tropacin was less effective. CONCLUSION: Tropacin is effective and safe medicine for treatment of IDUS and DHR.