New-generation synthetic implants for the surgical correction of pelvic organ prolapse and stress urinary incontinence: design and testing

Introduction. Up to 50.0% of postpartum women experience stress urinary incontinence (SUI) and pelvic organ prolapse (POP). One of the most common and pathogenetically substantiated methods for surgical correction of severe SIU and POP is prosthetic reconstruction of the pelvic floor, involves the use of monofilament polypropylene surgical meshes through vaginal or laparoscopic access.. However, this way is associated with specific problems, i.e., primarily mucosal erosions, and pelvic pain. This has served as a trigger for the development of new materials that reduce the likelihood of such side effects.Objective. To develop the new-generation synthetic implants for surgical correction of stress urinary incontinence and pelvic organ prolapse.Materials and methods. The main development stages: 1. design of an experimental sample of a synthetic implant (evaluation of basic, physical and mechanical properties). 2. test of an experimental sample obtained in vitro.Results. A bioresorbable polypropylene ligature delivery system was developed and manufactured in two variants: for the POP correction (mesh tape with a width of 13 – 15 mm) and for the SUI correction (mesh tape with a width of 10 – 11 mm).Conclusion. Based on the results of the in vitro tests, we can conclude that the synthetic implants developed are able to provide physiological longitudinal (axial) support of the necessary pelvic floor sections and reduce the risk of postoperative complications. Further in vivo studies are required to assess the response of living tissue to the implantation of this type of synthetic implants

Efficacy of a synthetic middle urethral sling in patients with mixed urinary incontinence

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p < 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p < 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence

Efficacy of focused shock-wave therapy in the treatment of chronic prostatitis / chronic pelvic pain syndrome in men

Introduction. Chronic prostatitis / Chronic pelvic pain syndrome (CP / CPPS) is an extremely common condition for which no effective treatment has been found yet. Focused shockwave therapy (fSWT) is a safe method of physical intervention that could potentially be effective in CP / CPPS treating.Objective. To evaluate the efficacy and quality of life of patients after treatment of CP / CPPS with fSWT.Materials and methods. A prospective cohort study included 48 patients diagnosed with CP / CPPS. The patients attended the clinic three times a week for 4 weeks (12 sessions). Each time, patients received fSWT therapy sessions by “Chronic pelvic pain” protocol. One month after the last therapy session, the men completed the validated NIH-CPSI, IPSS, and QoL questionnaires.Results. The mean age of the patients was 40 ± 9 years. After the course of therapy, the score of Domain I “Pain” from 10.0 ± 4.7 to 6.3 ± 1.9 (p < 0.001). At the same time, no statistically significant decrease was obtained in Domain II 'Urination' scores ((5,88 ± 2,40 vs 5,42 ± 1,64; p = 0,11). By the end of therapy for Domains III and IV, the scores had changed from 4.42 ± 0.90 and 4.04 ± 1.27 to 4.48 ± 1.01 and 3.08 ± 1.22, respectively (p < 0,001). It is noted that the mean IPSS questionnaire score showed no statistically significant change over the treatment period (17,2 ± 4,8 vs 17,8 ± 4,8; p = 0,074)). QoL changed from 4.48 ± 0.99 to 2.46 ± 1.03 (p < 0.001).Conclusion. The study demonstrated the efficacy of fSWT as a standalone method in the treatment of CP / CPPS

The role of electroneuromyography evaluation of the bulbocavernosal reflex in the diagnosis of pelvic nerve damage in patients with chronic pelvic pain syndrome

Introduction. One of the additional instrumental methods for diagnosing pudendal neuropathy is needle electroneuromyography (ENMG) of the bulbocavernosus reflex (BCR). The accumulated data on ENMG BCR in patients with primary chronic pelvic pain syndrome (CPPS) are insufficient due to the specificity of the procedure and its performance only in expert centres that specialise in the treatment of pelvic pain. Therefore, a study to investigate the features of ENMG BCR in patients with CPPS is of increased interest.Objective. To assess the representativeness and informativeness of the ENMG BCR technique in patients with CPPS and to identify factors influencing changes in the main parameters of the BCR M-response such as latency, amplitude, and duration.Materials & methods. Retrospective cohort study, which included 75 data from patients with (CPPS) who underwent needle-guided ENMG recording of BCR. Subjective complaints of patients were recorded using validated questionnaires: visual analogue scale (VAS) and chronic prostatitis and male pelvic pain syndrome symptom scale index (NIH-CPSI). Basic ENMG parameters such as the amplitude, latency, and duration of the M-responses were recorded.Results. We found statistically significant correlations between the duration and height of the M response of the patients (r = 0.31, p = 0.03) and their body weight (r = 0.34, p = 0.02). Anthropometric data did not correlate with amplitude and latency. Significant excess latency above 45 ms was observed, confirming nerve tissue destruction, in 11 (55%) women and 24 (44%) men. Although there were no statistically significant differences in any of the M-response parameters between men and women, there was a tendency for an increase in response amplitude in men and an increase in BCR latency time in women.Conclusion. The results of our study show that the duration of the M-response of BCR can correlate positively with the anthropometric data of the patient. At the same time, the mean latency and amplitude of the response are independent of anthropometric data, and the difference between them may be more determined by sex differences

Urinary pH: its regulation and relevance in urolithiasis metaphylaxis

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence

ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE

Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.Aim. To evaluate the results of complicated stress urinary incontinence (SUI) surgical treatment using a transobturator adjustable sling Urosling (Lintex).Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS).Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89) patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89) patients. In 3.4% (3/89) women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89) patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO). Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84) of the patients were «very» or «very» satisfied.Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the risk of postoperative BOO development

Transvertebral magnetic neuromodulation for the treatment of overactive bladder: 6 months follow-up

Introduction. The most common type of lower urinary tract dysfunction is an overactive bladder (OAB). Today there is a need to search for new effective methods of treating this disease.Purpose of the study. To evaluate the effectiveness of transvertebral magnetic neuromodulation (TMN) of the lumbar spine in patients with OAB.Materials and methods. 26 patients were enrolled in the clinical study. The treatment course consisted of 15 procedures (3 times a week for 5 weeks). Before and after treatment at 1, 3 and 6 months, complaints were assessed using the ICIQ-SF and OAB-q SF questionnaires. Objective parameters were assessed by urodynamic tests before and 6 months after treatment.Results. We observed a significant improvement in patients subjective clinical status at all points of assessment. Transvertebral magnetic neuromodulation had the greatest influence on such urodynamic parameters as the first sensation, the first desire, strong desire, maximum cystometric capacity. Patterns of phase hyperactivity were absent in 60.8% of patients after treatment and terminal hyperactivity in 41.7% of patients.Conclusions. This small study observed a significant therapeutic effect of TMN in patients with OAB. Further large placebo-controlled trials are needed to develop universal effective protocols for lower urinary tract dysfunction treatment