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Aim. To outline the importance of nocturia in benign prostatic hyperplasia (BPH) and justify the feasibility and clinical need for antidiuretic therapy in these patients. Materials and methods. This article is a literature review. PubMed, Embase, and eLibrary databases were used for the search. Relevant publications were included in the literature review. The pilot study included 20 male patients aged 58–75 years with a confirmed diagnosis of BPH. Patients were divided into two groups: standard therapy (Tamsulosin Canon) and combined therapy (Tamsulosin Canon + Nourem). Diurnal diuresis was assessed based on the results of the Zimnitsky test and the nocturnal bladder volume index before and after treatment. Results. During standard therapy, patients had a decrease in the severity of obstructive and irritative symptoms and an improvement in the QoL index (p0.05). However, there was no significant improvement in nocturia. In the combined therapy group, the severity of symptoms significantly decreased by 53.3%, and the QoL index improved by 62.5%. On average, the sleep duration increased by 1.5 hours with almost unchanged rates of daily diuresis. Conclusion. The study showed that in 65% of patients, nocturia was caused not by anatomical and functional changes in the prostate and lower urinary tract but by nocturnal polyuria. Its management has a major role in nocturia treatment. The only pathogenesis-based treatment is the antidiuretic therapy (desmopressin) added to the α1-blocker.

Introduction Overactive bladder syndrome poses a major challenge to healthcare, as an accurate estimate of its prevalence proves elusive due to patients' reluctance to disclose the embarrassing symptoms that accompany the disorder. Symptoms such as frequent urination, nocturia and incontinence are not only distressing but also significantly impair patients' quality of life. Effective diagnosis and treatment require the identification of associated risk factors, and behavioural therapy serves as the basis for implementing lifestyle modifications. This comprehensive study delves into the managing of overactive bladder syndrome, shedding light on recent advances in diagnosis and treatment. In particular, it looks at the integration of minimally invasive techniques and new medications that promise to not only alleviate symptoms, but also significantly improve patients' overall quality of life. Aim of the study This review aims to identify risk factors, symptoms, methods of diagnosis of overactive bladder syndrome and solutions in its treatment process. The main aim is to present treatment methods with the latest developments. Material and method This article presents the current state of knowledge about overactive bladder syndrome in various scientific articles. Publications describing overactive bladder syndrome, its symptoms, impact on life comfort and treatment options, including recent reports in the field, were reviewed using the PubMed platform. The search included the keywords ‘overactive bladder’, ‘urgency urinary incontinence’, ‘anticholinergics’, ‘mirabegron’, ‘nocturia’.

Introduction. Lower urinary tract symptoms (LUTS) are common in men and are associated with a significant decrease in quality of life. To date, there is no universal approach to the treatment of LUTS, which determines the need to search for new methods for influencing the lower urinary tract.Purpose of the study. To test the hypothesis that the use of peripheral magnetic neuromodulation (PMN) in male patients with LUTS will reduce the severity of LUTS.Materials and methods. Sixty-eight men with LUTS were enrolled in a prospective, randomized study. Patients were randomized in a 1:1 ratio for PMN or drug therapy with an alpha-1-blocker (tamsulosin). The primary endpoint was a reduction the LUTS severity such as urinary frequency during the day, nocturia and urgency as assessed using the IPSS questionnaire and urination diary. Improvements in urodynamic parameters such as maximum urine flow rate (Q max), mean urine flow rate (Q ave), and residual urine volume (PVR) were the secondary endpoint of the study. The results were evaluated on equal terms (10 days and 1 month) in both groups.Results. Sixty-seven (98.5%) subjects were included in the final base. Ten days after the start of therapy in the magnetic stimulation group, symptom relief was noted by 21 people (61.7%), the mean IPSS score showed a decrease from 18.1 ± 2.1 to 16.9 ± 3.2 points (p = 0.037). The number of urinations per day decreased from 14 (6 - 20) to 10 (6 - 14) times (p < 0.001). Objective indicators of urodynamics did not change in both groups. At a period of 1 month, PMN occurred in 22 (64.7%) patients, the IPSS score was 16.6 ± 3.7 points (p = 0.032), the number of urinations 9 (6 - 14) times (p < 0.001). Objective indicators have not changed. In the tamsulosin group, IPSS score changed from 19.27 ± 5.08 to 15.4 ± 4.85 (p < 0.001), Q max 14.36 ± 2.82 ml/s increased to 15.94 ± 2.71 ml/s (p = 0.032), while the Q ave did not change (p = 0.17). The number of urinations decreased from 13 (6 - 19) times to 10 (6 - 14) times (p

Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base.

Background One of the relevant tasks of modern urology is the correct understanding of symptoms of the lower urinary tract (LUTS). The social aspect of overactive bladder syndrome (OAB) and the lack of objective ways for non-invasive diagnostics make it necessary to search for new study methods. There is increasing evidence that urination diary can be a clinically powerful tool for assessing bladder sensation, especially in cases of obtaining information not only about the volume of micturition, but also about the degree of urgency with each individual urination. To date, several tools have been developed to assess the severity of OAB, including the international scale of Overactive Bladder Symptom Score (OABSS), proposed by Y. Homma and J. G. Blaivas in 2006–2007.Objective Тo identify the most significant signs of urgency in men with benign prostatic hyperplasia and overactive bladder with and without detrusor hyperactivity (DH).Material and Methods To assess the OAB, patients completed the OABSS, visual analogue scale (VAS), and also kept urination diaries. After the results were obtained, the severity of symptoms was evaluated, considering the data of the urination diary. All patients underwent a complex urodynamic study (CUDI), the results of which were compared with subjective criteria for the severity of urgency and the most significant clinical signs of detrusor hyperactivity.Results Against the background of the analysis of the data obtained, it was possible to classify nocturia by type in 93 patients. One patient (1.07%) had diurnal polyuria. Nocturnal polyuria was in 39 (41.9%) people. Decreased bladder capacity was found in 43 (46.2%) men. Ten (10.7%) patients had various sleep disorders. The IPSS was 24 ± 0.91, the mean score was 14 ± 0.7 points for irritative symptoms according to IPSS (questions 2, 4 and 7) and 13 ± 0.8 points for obstructive symptoms. From the data reported by CUDI, spontaneous detrusor activity was detected in 49 (43.7%) patients, in 63 (56.2%) it was not registered. When analyzing the VAS, it was found that the urgency in patients with BPH and DH, reflecting the initiation of the urge to urinate, is 31 ± 0.6 mm (p < 0.05). On average the indices of the difficulty of holding the urge are higher by 2.9 ± 0.2 points (p < 0.05) in those patients who have DH. When answering the question "How often cannot you retain urine with a strong sudden urge?", the indicators were recorded higher by 3.1 ± 0.3 points (p < 0.05), in patients with detrusor hyperactivity.Conclusions In patients with BPH and the presence of urgency, the frequency of the urge to urinate is 32% higher, and the difficulty of maintaining the urge is 46% more pronounced, compared with the examined men who do not have detrusive hyperactivity.

Aim. To evaluate the effectiveness and tolerability of the drug fezoterodin in older patients with оveractive bladder (OAB). Materials and methods. In 2019, 50 women with OAB aged 50 to 82 years (average age was 67.512.5 years) were treated in the framework of donation of the drug fezoterodin (Toviaz). The patients were divided into two groups: group 1 included 25 women had received treatment with fesoterodine dose of 4 mg per day for 12 weeks, group 2 consisted of 25 women, the fesoterodine dose to 8 mg per day for 12 weeks. The diagnosis of OAB was confirmed by a urodynamic study. Results. 48 (96%) patients out of 50 completed a 12 week course of treatment. The efficacy and tolerability of the drug fezoterodin in both groups was 93.7%. Mild adverse events (dry mouth, constipation, blurred vision) were observed in 11 (22.9%) patients out of 48 treated. None of the women had cognitive impairment (memory impairment, decreased concentration, drowsiness, impaired thinking and orientation). Conclusion. Our experience with M-cholinoblocator fezoterodin showed statistically and clinically significant improvements in all symptoms of OAB, as well as good tolerability of the drug in patients aged 50 to 82 years.

Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia traditionally has been regarded as a predominantly male condition, but it is just as prevalent in women as in men. Urologists and general practitioners are becoming increasingly aware of and interested in nocturia, as indicated by the recent increase in large epidemiologic studies and analyses and by initiatives such as the Nocturia Think Tank and The Consensus Statement from the Interdisciplinary Conference on Nocturia. Nocturia is a common symptom of many conditions and is encountered in patients presenting to services across different medical specialities and health disciplines. The causal pathway of nocturia is multi-factorial and differs between patients. There is currently no symptom-specific clinical algorithm for all-cause diagnosis of nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient’s nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient’s nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturia is a complex multifactorial condition that requires careful evaluation for appropriate diagnosis. The FVC is an essential evaluation tool that can facilitate accurate identification of the potential multiple causes of nocturia in an individual patient, providing evidence by which the etiology of nocturia can be categorized into one or a combination of categories of sleep disorders, nocturnal polyuria, global polyuria, and reduced bladder capacity. The role of the circadian clock in the pathophysiology of nocturia deserves further attention.

This review is to evaluate literature concerning different methods of treatment of anterior urethra strictures: internal optical urethrotomy (OIU), laser urethrotomy, urethra stenting, urethra dilatation, OIU in combination with selfdilatation, OIU combined with chemicals injection. Evaluation of expedience, advisability and reasonableness of the chosen methods and techniques. Hereby presented statistical assessment of longtime postoperative data, low efficiency researches analysis. This research is compiled using Medline, PubMed and Embase databases.

Objective: Evaluation of nocturia and its relationship with clinical characteristics of Parkinson's disease (PD) and dopaminergic therapy., Material and Methods: One hundred and thirteen patients with PD of I-III Hoehn and Yahr stage (H&Y) were examined using the following scales: IPSS, including nocturia domain, UPDRS, Sch&En, PDQ-39, MMSE, FAB , BDI, STAI-S and STAI-T, PFS-16, NMSQuest, GDSS, GSRS, and orthotest., Results: Nocturia was detected in 93 patients. It depended on the age of the patients (rS=0.345; p <0.001) and was more spread among women ( p =0.002). We obtained positive correlations of nocturia ( p <0.05) with: PDQ-39 (rS=0.296), H&Y (rS=0.223), UPDRS (rS=0.265) and its items (speech, walking disorders, standing up from chair, posture and postural stability), NMSQ (rS=0.318), FAB (rS= -0.359), BDI, STAI-S and STAI-T, PFS-16, gastrointestinal parameters and blood pressure in the supine position. No significant effect of dopaminergic therapy on the severity of nocturia was found. According to regression analysis (stepwise method), predictors of nocturia are depression, higher lying blood pressure, constipation and postural instability (R2=0.474)., Conclusions: Nocturia is the most common urological symptom in patients with PD and it significantly reduces the quality of life starting from the early stages of the disease. Nocturia increases as PD progresses, it is independent of dopaminergic medications, and it is directly associated with a number of parkinsonian symptoms (postural, frontal cognitive, affective and autonomic), which are partly dopamine-resistant. This indicates the common pathogenesis of nocturia and other symptoms of PD and the significant influence of polytransmitter imbalance.

An overactive bladder (OAB) is a constellation of lower urinary tract symptoms, including urgency, increased frequency of urination during the day and/or night (nocturia), and, in some cases, urge incontinence. This syndrome can be caused by different conditions, and currently no universal pathogenetic treatment has been developed. In addition, there are virtually no Russian-language publications providing information on the neurophysiology and neuroanatomy of the lower urinary tract. At the same time, the importance of this topic can hardly be overestimated. Often, a patient with a neurogenic dysfunction of the lower urinary tract has different comorbidities, which requires to deeply understand the mechanisms of development of certain symptoms. Considering an absence of clear data about the peripheral bladder innervation, role of the structures of the central nervous system and importance of neurotransmitters, it is rather difficult to provide high-quality specialized care. However, in recent years, a lot of new facts and theories have been described in basic researches. This lecture is dedicated to the current data on the pathogenesis of OAB. The purpose of the lecture is to summarize the results of fundamental and clinical studies on the pathogenesis of OAB.

Aim: Parasomnia, a syndrome of rapid eye movement sleep behavior disorder (RBD), is a common non-motor impairment in patients with Parkinson's disease (PD). The relationship between RBD with other symptoms of PD affecting night sleep, in particular, nocturia, is understudied. An aim of the study was to determine the symptoms related to night sleep disturbances in PD patients with RBD and assess the dynamics of these disturbances with the disease progression taking into account RBD onset., Material and Methods: One hundred and forty patients (72 male and 68 female) with PD without dementia (mean age 61.98±0.79 years, PD stage - 2.35±0.05, duration 5.82±90.65 years) were examined. Motor disorders were assessed with the unified Parkinson's disease rating scale (UPDRS), sleep disturbances and frequent night urinations were evaluated with the Parkinson's Disease Sleep Scale (PDSS). The diagnosis of probable RBD was based on reports of patients or their relatives on the dream-related motor activity and vocalization. Quality-of-life was evaluated with the Parkinson's Disease Questionnaire (PDQ-39). Patients were followed up after 2.5 years., Results: Probable RBD was diagnosed in 46.43% of patients, including 30.77%, who developed the syndrome before the manifestation of motor symptoms, 16.92% patients with simultaneous development of RBD and motor symptoms and 52.31% with RBD development >2 years after motor disorders. Patients with RBD differed from those without parasomnia by the higher severity of nocturia. After 2.5 years of follow-up, the severity of disease was greater in patients with RBD assessed by UPDRS, quality-of-life indices, severity of nocturia and episodes of nocturia. The highest frequency of episodes of nocturia was noted in patients with early onset of RBD before the manifestation of motor symptoms., Conclusion: RBD in patients with PD is associated with the rapid progress of nocturia, higher degree of worsening of daily activities and deterioration of quality of life. The relationship between RBD and progression of nighttime urination suggests common pathophysiological mechanisms of their development, which include the structural changes in the brain stem nuclei. The diagnosis of RBD is one of the markers of spreading of neurodegenerative pathology into the brain stem that resulted in the unfavorable disease course.

The article presents the data of Russian and international epidemiological studies on the prevalence of various lower urinary tract symptoms (LUTS) among male and female populations. The overall summary of these data highlights the need for the national data on LUTS prevalence, severity and impact on quality of life to project the spending for LUTS management.

Purpose: to evaluate the prevalence of various urination disorders in residents of the Republic of Dagestan, and, thus, to improve their diagnosis and treatment., Materials and Methods: 584 residents (264 men and 320 women) from different regions of the Republic of Dagestan took part in an anonymous questionnaire survey: 165 residents of Makhachkala, including 92 men and 73 women; 86 residents of Derbent and villages of Southern Dagestan, including 30 men and 56 women; 73 residents of Khasavyurt and Kizilyurt, including 34 men and 39 women; 53 residents of Buynaksk, including 19 men and 34 women; 42 residents of Izberbash, including 19 men and 23 women; 58 residents of the Kaspiysk, 29 men and 29 women; 42 residents of Kayakent, 4 men and 38 women; 65 residents of other regions of the Republic of Dagestan (Karabudakhkent, Gumbet, Gunibsk, Shamil, Khunzakh, Botlikh, Kazbek, Levashin, Tlyaratin, and Tsumadin regions), 37 men and 28 women., Results: According to the survey of the residents of the Republic of Dagestan, a significant prevalence of various urinary disorders (63.5%) was found among both men (61.7%) and women (65.0%). Unfortunately, not all patients seek medical advice with complaints of dysuria (55.5%). The fact that 18.8% of patients do not know that they can get help, and 24.1% believe that they do not have a good doctor in their region can be considered as the most an unfavorable moment in terms of the reasons for the refusal of visiting a doctor.., Conclusions: All this findings suggest the need for educational programs both for physicians and the population (educative activities).

The study was aimed to the evaluation of the effect of the components of the metabolic syndrome (obesity, insulin resistance (IR)) and androgen deficiency on the clinical course of lower urinary tract symptoms against the background of benign prostatic hyperplasia (LUTS/BPH) and nocturia, as well as on some of the parameters of BPH (prostate volume, residual urine volume, total prostate-specific antigen (PSA) blood level). The comprehensive survey of 160 men with LUTS/BPH (mean age 56.7 ± 3.3 years) was performed; based on the results of survey, three comparison groups were formed: Group 1 (n = 70)--patients with isolated obesity; Group 2 (n = 36)--patients with obesity and insulin resistance; and Group 3 (n = 54)--patients with obesity, insulin resistance and androgen deficiency. The control group consisted of 30 patients with LUTS/BPH without these metabolic and hormonal disorders. In patients with LUTS/BPH and obesity, higher frequency of nocturia compared with the control group was revealed (63.7% vs 23.3%; P < 0.05), as well as the relationship between the waist circumference and free testosterone level (n = 160; r = -0.322; P = 0.005) and waist circumference and total prostate volume (n = 160; r = 0.121; P = 0.005). In patients of Group 2, significant positive correlation between waist circumference and blood insulin level was identified (n = 36; r = 0.461; P = 0.005). Patients with obesity, insulin resistance and androgen deficiency had the highest average prostate volume and residual urine volume compared with those of other groups (P < 0.05). Thus, obesity, insulin resistance, androgen deficiency are associated pathological conditions, greatly aggravating the clinical course of LUTS/BPH due to adverse impact on the BPH parameters, acting both together and separately. The most severe LUTS/BPH were associated with the presence of all three of the above systemic disorders.