[Principles of continence in women: the formula of continence].

Urinary incontinence in women is a widespread disease . In recent years, significant progress in its treatment was achieved. Despite this, the mechanisms of continence are still poorly understood. According to the principles of biomechanics, incontinence occurs when bladder pressure exceeds urethra pressure. We represent the formula for calculating the pressure loss of urine, which takes into account the main factors involved in the formation of urethral pressure. According to our data, the involuntary leakage of urine during physical conditions may occur if the bladder pressure exceeds intraurethral pressure, which can be calculated using a formula based on urethral closing pressure and passive resistance of the bladder neck.

[Analysis of the results of urinary incontinence treatment in women using free suburethral synthetic sling: the experience of 1000 operations].

The study presents an analysis of the experience of treatment of urinary incontinence in women using free synthetic suburethral sling. Between 2001 and 2008, 1081 patients underwent surgery. Of these, 841 (77.8%) suffered from stress urinary incontinence, 202 (18.62%) suffered from the mixed form of urinary incontinence with a predominance of the stress component, and 38 (3.52%) had recurrent urinary incontinence. Group 1 included patients with stress urinary incontinence who underwent surgery using suburethral synthetic sling with retropubic access (TVT operation); Group 2 included patients, who underwent surgery using suburethral sling implanted with transobturator access (TVT-O operation). Group 3 consisted of patients with mixed urinary incontinence, who underwent TVT-O operation. Retropubic suburethral TVT sling was implanted in 273 (25.25%) patients, transobturator TVT-O sling--in 740 (68,45%) patients, and other synthetic suburethral slings--in 68 (6.3%) patients. The average follow-up period was 50.1, 31.1 and 32,6 months in each group, respectively. Cough test was used for the objective evaluation of the effectiveness, and visual analogue scale--for the subjective evaluation of effectiveness. In the TVT group, the negative cough test in the postoperative period remained at 85.58% of the patients, and in in TVT-O group--in 84.36% of patients. Analysis of the frequency of intraoperative complications showed that the probability of occurrence of complications was not associated with age, body mass index and obstetric history of patients. It was noted that the perforation of the bladder and pelvic hematoma were more likely to occur when using the retropubic access. Transobturator access is associated with a higher risk of injury of the lateral vaginal fornix, although bladder injury is not ruled out. Objective and subjective indicators of efficacy of treatment of mixed form of urinary incontinence were 86.15 and 87.69%, respectively. The study suggests that the operations using suburethral TVT and TVT-O slings are safe and effective methods of treatment of stress urinary incontinence in women.

[Flexible approach to the appointment of solifenacin: for whom and when?].

Solifenacin at a dose of 5 mg per day has demonstrated the high efficacy in the treatment of patients with overactive bladder. However, for patients who remained dissatisfied with the outcome of treatment, the dose may be increased to 10. mg per day, which leads to the improvement of patient's condition. However, there is an opinion that treatment should be started with the use of high doses of the drug. Efficiency of solifenacin at a dose of 10 mg was accompanied by favorable safety and tolerability profile. Despite the fact that numerous studies have shown that the clinical efficacy of different anticholinergics is not very different from one another, it is known that patients may prefer some other drugs. Application of solifenacin in these patients leads to significant improvement in quality of life. Thus, flexible approach to the use of solifenacin allows to achieve the best results in the treatment of patients, including those cases where the initial treatment is not effective or is interrupted due to pronounced side effects.

[Methods of diagnosis and treatment of asymptomatic bacteriuria in postmenopausal women suffering from type 2 diabetes mellitus].

We studied prophylactic potential of local use of estriol in respect of urinary infections (UI) in postmenopausal women with asymptomatic bacteriuria (AB) suffering from type 2 diabetes mellitus (DM). A two-stage trial has been conducted. Stage one (a prospective study) was made to detect AB in DM women with AB. Of 414 female examinees AB was detected in 87 women. At stage two these women were randomized into two groups: group 1 received 0.5 mg estriol as vaginal cream, group 2 (control) received no prophylactic treatment. After 9 months of the trial AB was detected in 19.4% women of group 1 and 68.4% of the control group (p<0.001). Clinically significant UI was detected in 8.3 and 18.4% examinees (p<0.001), respectively. No correlation was found between AB development and a HbA1c level. Estriol treatment resulted in a rise of vaginal health index (VHI), appearance of lactobacteria in the vaginal smear, lowering of atrophic vaginitis detection rate. No significant changes were registered in the controls. Thus, local estriol administration effectively prevents and treats UI in postmenopausal females.

[Mini-invasive operations for correction of urinary incontinence in females].

We compared efficacy of surgical treatment of urinary incontinence in women depending on the size of the synthetic sling and technique of its installation. From January to September 2009 we made 75 operations with synthetic suburethral slings: TVT-SECUR (TVT-S)--group 1 (n = 35) and TVT-O- group 2 (n = 40). The sling was installed in U position in 14 patients of group 1 and in H position in 21 patients. The control examinations included questionnaire survey, cough stress test (in bladder volume more than 150 ml), vaginal investigation, uroflowmetry, in urgency--complex urodynamic examination. A total of 32 patients of group 1 and 40 patients of group 2 were examined postoperatively. A positive result was achieved in 20 (62%) and 38 (95%) (p = 0.0006) patients of group 1 and 2, respectively. Quality of life was assessed as good and very good by 22 (68%) and 37 (93%) patients of groups 1 and 2 (p = 0.0105), respectively. The control examination after 6 months of follow-up showed good result in 7 (53%) and 13 (68%) patients of group 1 (subgroups U and H, respectively). Reoperation for urinary incontinence was made in 4 (30%) patients of subgroup U and 1 (5%)--of subgroup H. Thus, surgical treatment of urinary incontinence in women according to TVT-0 technique is more effective than in TVT-S surgery, but minisling TVT-S is more effective in patients with bad somatic status and in H position.

[Effects of synthetic materials used for the treatment of genital prolapse on lower urinary tract function].

Functional results of surgical correction of genital prolapse were compared with those of transvaginal implantation of the prolift in 26 and 22 women, respectively. Standard protocol required gynecological examination, cough test, complex urodynamic investigation. Patients of both groups were matched by anthropometric parameters. All the patients were reexamined 1, 3 and 6 months after surgery. Comparison of the results showed that most of the urodynamic parameters changed insignificantly in patients treated surgically for prolapse of the urinary bladder. Moreover, there was no significant association between these findings and surgical methods of the prolapse treatment. Stress urinary incontinence arose in 13.64% (3/22) patients who had undergone prolift implantation and in 3.85% (1/26) patients after colporraphy. Postoperative overactive bladder was observed in 9.09% (2/22) and 11.54% (3/26) patients, respectively. No significant difference by the above symptoms between the groups were registered in relation to the operation type. Similar data were obtained in respect of incidence of lower urinary tract infections. Thus, it is found that prolift plastic operations for cystocele do not increase the incidence of urinary incontinence, overactive bladder, lower urinary tract infection. Further studies with greater number of patients and longer follow-up are needed.

[Hyperbaric oxygenation in combined treatment of interstitial cystitis].

A total of 116 female patients with painful bladder syndrome/interstitial cystitis aged 32-78 years (mean age 56 +/- 2.4 years) entered the trial. They were divided into two groups according to treatment. Group 1 (n = 54) received 10-day combined conservative treatment consisting of antimicrobial drugs (if urinary infection was diagnosed), angioprotectors, mast cell activity stabilizers and bladder instillation with combined solution. Group 2 included 62 patients whose treatment included complex anti-inflammatory therapy in combination with HBO sessions (7-10 sessions in barochamber OKA-MT, 2.0 +/- 0.2 atm). Subjective (the disease course, pain intensity, 24-h and nocturnal pollakiuria, effective urine volume) and objective (microcirculation in the bladder wall) results were assessed. Dopplerograms revealed venous stagnation. Patients of group 2 had a persistent improvement of microcirculation in bladder mucosa as shown by better blood flow in the veins and arterioles. In group 1 the above improvement was less pronounced. Thus, HBO in combined treatment of interstitial cystitis improves treatment results and promotes long-term remission of the disease.

[Remote results of using synthetic loop in the treatment of urinary incontinence in females (8-year study results)].

Out of 21 female patients who had undergone TVT operation for stress urinary incontinence from March 2000 to February 2001, 15 females responded to the interview in the telephone survey conducted in 2009. A Russian version of the King's Health Questionnaire was used. Seven (46.8%) patients assessed the effect of the operation as good, 4 (26.6%) patients--as satisfactory, 2 (13.3%) and 2 (13.3%) as bad and poor, respectively. Thus, a positive effect was achieved in 11 (73.4%) responders, while a negative effect was seen in 4 (26.6%) patients. Nine (60%) patients experienced no effect of urination problem on quality of life, 3 (20%) and 3(20%) patients experienced moderate and strong effect, respectively. Frequent voiding, urgencies at night, imperative voiding and urgent urinary incontinence were recorded in 3 (20%), 4 (26.7%), 2 (13.3%) and 2 (13.3%) patients, respectively. All 15 (100%) responders stated no incontinence in cough, sneezing and physical activity. Thus, our 8-year follow-up confirms that TVT operation is highly effective in stress urinary incontinence in women.

[Anatomic characteristics of transobturative approach in application of a tension-free tape for treatment of women with stress urinary incontinence].

We studied safety and topographic characteristics of a transobturative approach in application of an "inside out" tension free tape (TFT) for management of stress urinary incontinence (SUI) in women. The anatomic sections were made on 6 fresh female cadavers (mean age of the deceased 78.5 +/- 4 years). After the tape placement a femoral section was made with its extension to the perineum and retropelvic section. We found that the TFT passes far from the major femoral structures. The distance from the obturator canal to the TFT averaged 24.4 mm +/- 1.8 mm (from 23.9 to 30.4 mm, median 21.4 mm). Dissection of the dorsal nerve and artery of the clitoris as well as the pudendal nerve showed that these structures are not damaged in correct operative technique. Moreover, the tape passes beneath the pelvic fascia and levators, it does not penetrate the pelvic cavity. Thus, the transobturative approach is safe, does not damage vital organs and anatomic structures in the treatment of women with SUI.

[The free synthetic loop in the treatment of urinary stress incontinence in women: comparative analysis of postoperative complications].

Operations with application of a free synthetic loop were made in 504 female patients with urinary stress incontinence (USI). The patients were divided into two groups. Patients after TVT operation, not operated with reconstruction of the pelvic fundus entered group 1 (n = 207). Patients after TVT-0 operations (n = 109) entered group 2. The data were processed with the criterium chi-square, significance was stated in p < = 0.05. The following intra- and postoperative complications were registered: de novo imperative symptoms, pelvic hematoma, perforation of the urinary bladder. The latter complication occurred in 1 (0.48%) patient of group 1 and in none from group 2. Pelvic hematomas were in 2.9 and 0.92% patients, respectively. De novo imperative symptoms were observed in 2.9 and 1.83%, respectively. It was stated that differences in complications between the groups were insignificant. Further multicenter controlled randomized studies are necessary.