[A comparative analysis of intravesical sodium hyaluronate monotherapy and its combination with oral chondroitin sulfate in patietns with bladder pain syndrome/intersticial cystitis].

AIM: It is established that intravesical sodium hyaluronate and chondroitin sulfate has high efficacy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). Currently, an oral form of chondroitin sulfate is also available. The aim of study was to compare the efficacy of intravesical hyaluronic acid monotherapy and long-term oral chondroitin sulfate in combination with intravesical therapy in patients with BPS/IC. MATERIALS AND METHODS: A total of 59 patients with BPS/IC were randomized in two groups. In Group 1, 30 women (mean age 57.1 years) received viscoelastic solution of sodium hyaluronate 50 ml 1 time per week for 12 weeks as intravesical monotherapy. In Group 2 (n=29), patients were prescribed to complex therapy, which included the similar intravesical therapy combined with chondroitin sulfate in a dose 0.39 g, 2 capsules 3 times a day, also for 12 weeks. All patients completed visual analogue scale (VAS), interstitial cystitis symptom index (ISCI), interstitial cystitis problems index (ICPI) and voiding diary before and 1 week after the start of therapy. In all cases a cystoscopy and urodynamic study were performed in order to exclude other bladder pathologies. RESULTS: At baseline, a mean VAS score in both groups was 7 points, a mean ISCI score was 17 points in Group 1 and 18 points in Group 2 (p>0.1). The mean ICPI score in both groups was 15 points. A frequency of urination in Group 1 and 2 was 11.4 and 11.6 per day, respectively (p>0,1). A mean volume of urination was 138+/-24.6 and 131+/-18.6 , respectively. After 12 weeks of therapy there was significant improvement of VAS, ICSI and ICPI scores in both groups, as well as frequency and volume of urination, but in Group 2 an improvement in almost all parameters studied, except for the volume of urination, was more pronounced. CONCLUSION: The combined therapy of BPS/IC with intravesical hyaluronic acid and oral chondroitin sulfate provides significantly better results in comparison with intravesical hyaluronic acid as monotherapy.

[Urodynamics study in patients with urinary incontinence, after surgical treatment of localized prostate cancer].

AIM: Radical treatment of prostate cancer (PCa) is often associated with the development of urinary incontinence (UI). The etiology of UI after prostatectomy is multifactorial and can be caused by both urethral sphincter deficiency and bladder dysfunction. To date, there are no comparative studies of the development of UI in patients after either organ-preserving treatment or radical prostatectomy (RP). Considering this fact, our aim was to carry out the comparative assessment of urodynamic changes in these categories of patients. MATERIALS AND METHODS: A retrospective study (n=158) was conducted. All patients were divided into three groups, depending on the method of treatment, HIFU (Group 1, n=32), retropubic RP (Group 2, n=46); robot-assisted RP (Group 3, n=80). The mean age was 71.8+/-3.68, 69.5+/-4.63 and 65.8+/-3.4 years in Group 1, 2 and 3, respectively (p<0.01). The average score was ICIQ-SF-14 points. The median follow-up was 2.7 years. In all cases a multi-channel urodynamics study in accordance with ICS standards was performed. RESULTS: Detrusor overactivity (DO) was detected in 22 (68.7%), 24 (52.1%) and 64 (80%) patients in Group 1, 2 and 3, respectively (p<0.001). In 14% of patients with DO (18%, 12% and 12% Group 1, 2 and 3, p<0.05), leakage test with stress provocative maneuver was negative. The decrease in the bladder compliancy was revealed in 75.9% of patients, and in 8.8% cases (n=14) it was associated with anatomical changes (12.5%, 8.6% and 7.5% in Group 1, 2 and 3, respectively, p<0.01). The mean maximum detrusor pressure was reduced in all patients. Bladder outlet obstruction was detected in 46.6%, 21.7% and 12.5% cases (p<0.001). There was no significant difference in the level of maximum urethral pressure in all groups, but it was significant in patients with negative breakdown at the threshold of abdominal pressure and DO (p<0.05, k=0.87). CONCLUSION: The high incidence of postoperative bladder dysfunction in patients of the studied groups revealed by us differs from the existing literature data, which dictates the need for a detailed assessment of bladder dysfunction when choosing a tactic for treating UI. In connection with the above, we consider it necessary to conduct further studies with a mandatory pre- and postoperative urodynamic assessment of the lower urinary tract in patients after surgical treatment of prostate cancer without UI.