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Introduction. Today there is many highly effective surgical approaches in the treatment of benign prostatic hyperplasia (BPH). New technologies in the treatment of BPH continue to be implemented. Despite this in some patients the results of surgical treatment for short-term and long-term monitoring is unsatisfactory.Purpose of research. Тo improve the results of treatment of patients with benign prostatic hyperplasiaMaterials and methods. The functional state of the urethral sphincter was studied in 123 patients with symptomatic BPH. According to the treatment method, all patients were separated into groups. Group 1 - patients with established standard indications for surgical treatment. After surgery, patients with persistent obstructive urination received therapy with a central muscle relaxant for three months. Group 2 - patients with uncomplicated BPH, having hypertonic urethral sphincter and receiving drug therapy according to the established urodynamic patterns.Results. Our analysis of the efficacy of surgical treatment of patients with BPH demonstrates a significant correlation between negative outcomes of surgery for BPH with increased tone of the external urethral sphincter. So, in 70.1% of cases, symptomatic obstructive Low Urinary Tract Symptoms (LUTS) in BPH were accompanied by increased tone of the urethral sphincter from standard parameters. We believe that these changes were related to the anatomical characteristics of nodular hyperplasia.Conclusions. Exactly this fact, that these patients had urethral sphincter dysfunction in 14.5% of cases made for poor effect of surgical treatment of BPH. Use of muscle relaxants centrally acting drug therapy in these cases, significantly improves the urodynamics of lower urinary tract, which is accompanied by regression of LUTS.

In Western countries, approximately 15% of all women suffer from stress urinary incontinence. The incidence is significantly higher among the elderly – more than 25% of older women suffer from this disease. If treatments such as exercise, medication, or electrical stimulation of the sphincter do not restore urine continence, then cell therapy can be used to improve the function of the urethral sphincter. The development of stress urinary incontinence in women is associated with a violation of the structure of the urethral sphincter, which ensures the integrity of the bladder. Violation of the sphincter structure is manifested by the loss of muscle cells and their replacement by connective tissue. This review provides readers with a brief summary of current knowledge about stem cells used to treat urinary incontinence – mesenchymal stromal cells, stem cells derived from urine and muscle satellite cells, as well as the knowledge on improving surgical navigation techniques, injections of cells into the sphincter muscle and prospects obtained from recent preclinical studies.

Background. The annual number of new cases of chronic pelvic pain syndrome in women of reproductive age is increasing worldwide. The high prevalence of this condition among the able-bodied female population leads to higher state expenditures on the treatment of this category of patients. New methods of diagnosis and early prophylaxis contribute to reducing economic burden associated with chronic pelvic pain syndrome in women and improving health of the female population as a fundamental demographic factor.Objectives. To determine somatic, obstetric-gynecological, anatomical, and psycho-emotional predictors of chronic pelvic pain syndrome.Methods. An observational cohort clinical and ultrasound study involved 60 patients of reproductive age. The study was conducted on the basis of the clinic for women, Voronezh City Outpatient Clinic No. 1 — clinical base of the Department of Obstetrics and Gynecology No. 2, Voronezh State Medical University named after N. N. Burdenko, Russia. According to clinical and laboratory data, the participants were divided into 2 groups. Group 1 (n = 30) included women of reproductive age without clinical manifestations of chronic pelvic pain syndrome; Group 2 (n = 30) enrolled women of reproductive age clinically diagnosed with chronic pelvic pain.Results. The mean age of the study participants in the main group comprised 27.4 ± 6.30 and 26.3 ± 7.25 years in the control group, p > 0.05. Diseases of gastrointestinal tract, endocrine, cardiovascular, musculoskeletal and urinary systems, as well as neurocirculatory and vegetative disorders prevailed in the structure of somatic pathology in the main group, p < 0.001. Analysis of obstetric and gynecologic anamnesis revealed no statistically significant differences in the incidence of gynecologic pathology in the study groups. However, according to the detailed analysis of the delivery history of the participants, 23 patients of the main group (76 %) and 3 patients (6.6 %) of the control group underwent episiotomy during labor, p < 0.001. The evaluation of the comparison groups in terms of pain component in myofascial syndrome involved the pain rating index, number of selected descriptors, sensory index of the selected descriptors, emotional index of the selected descriptors, and pain intensity. Statistically significant differences were revealed for all of the above indicators, thereby confirming a reliable picture of pathopsychological changes in the compared groups of women. The analysis of the ultrasound parameters of topographic and anatomical relationships demonstrated the relevant change in the following parameters: urethral length, diameter of the external urethral sphincter, angle between the external urethra and the body of the bladder, direct and transverse dimensions of the levator hiatus in the studied groups under the muscle tension.Conclusion. An issue of early diagnosis and prophylaxis of chronic pelvic pain syndrome in women of reproductive age remains urgent and requires interdisciplinary participation of medical specialists. The development of new approaches to ultrasound evaluation of pelvic floor will increase the effectiveness of therapeutic and prophylactic measures and reduce the economic burden of this nosology in the morbidity structure of the able-bodied female population.

Hypothesis/Aims of study. At present, there is no doubt about the importance of the problem of female stress urinary incontinence (SUI) and the search for the best way to eliminate it. Sling operations in SUI treatment are the most popular in world and domestic practice. However, they are not without certain complications. In this regard, it becomes relevant to determine the factors for predicting their effectiveness and safety. The aim of this study was to conduct a comparative study of the effectiveness of two anti-stress operations: TVT-Obturator® and urethrovesicopexy with vaginal flap, by using echography of the urethrovesical segment. Study design, materials and methods. During the period from 2011 to 2018, 105 incontinent patients were examined and operated on. Two groups were formed: Group 1 consisted of 52 patients who underwent TVT-Obturator® surgery, Group 2 included 52 patients who underwent urethrovesicopexy with vaginal flap. In all patients, the anatomical topographic position of the bladder and urethrovesical segment, the internal urethral sphincter status, as well as the angles α and β were determined, based on which the conclusion about the type of SUI was made and, accordingly, the adequate method of surgical intervention was determined. Results. Before the operation, the angle α averaged 37.2 ± 10.11, with 24.7 ± 4.64 a year after the operation and 26.8 ± 3.72 five years after the operation. Rotation of the angle α in the study groups >20° before surgery did not significantly affect the presence of long-term complications, urinary retention after a year and five years, and recurrence of urinary incontinence. After the operation, there was an increase in the angle β after a year (p = 0.0032) and five years (p = 0.0035) and in the total urethral length after a year (p = 0.0022), but after five years, this parameter did not differ significantly from that before surgery (p = 0.29). Conclusion. TVT-Obturator® and urethrovesicopexy with vaginal flap are equally effective (p > 0.05) in the surgical treatment of female SUI in both the nearest postoperative period (96.2% and 94.3%, respectively) and the distant period (90.4% and 88.7%, respectively). [ABSTRACT FROM AUTHOR]

Obesity is the accumulation of excessive adipose tissue in the body and is the most common nutritional disorder in pets. Obesity is one of the most prevalent health conditions in companion animals globally. It is associated with premature mortality, metabolic dysfunction, and multiple health conditions across species. Obesity is, therefore, of importance in the field of veterinary medicine. The regulation of adiposity is a homeostatic process vulnerable to disruption by many genetic and environmental factors. Among dogs, cases are found in 22–24 %, and among cats – in 20 % of animals that visited a veterinary clinic. Approximately one-third of cats older than 12 years of age may have a decreased ability to digest fat, whereas one in five may have a compromised ability to digest protein. More than 40 % of dogs between the ages of 5 and 10 years are overweight or obese. Among the risk factors that cause excessive fat deposition is noted: breed, age, sex, sterilization, lifestyle, endocrine diseases, drug treatment and contraception, feeding, social factor, and the number of animals in the household. Obesity, in turn, affects several metabolic processes and is a factor that affects the development of pathological processes: dyslipidemia, hyperlipidemia, insulin resistance, hyperinsulinemia, type 2 diabetes, excessive deposition of fat in the liver and pancreas, coronary heart disease, disease gallbladder, osteoarthritis, urethral sphincter dysfunction, may increase the risk of certain types of cancer. For research, two groups of cats aged 3–7 years were formed, but breed data were not taken into account. Laboratory blood tests confirmed the clinical observations of specialists regarding overweight cats. The pathoanatomical autopsy with subsequent pathohistological studies made it possible to finally confirm the diagnosis of obesity, which was accompanied by fatty dystrophy of internal organs.

This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.

Copyright of Neurosurgery & Neurology of Kazakhstan is the property of National Centre for Neurosurgery JSC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Neurosurgery & Neurology of Kazakhstan is the property of National Centre for Neurosurgery JSC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods., Materials and Methods: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure., Results: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didnt affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended., Discussion: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations., Conclusion: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.

The minimum and maximum indicators of the length, width, area or volume of organs and structures in the lower urinary tract can normally vary up to 2-3 times. With age, at healthy women the absolute and relative length of the urethra, the urethrovesical angle, and the inclination of the urethra do not change. Both smooth and striated muscle tissues, which are part of various departments of the female urethra, undergo atrophy during the aging process. Smooth muscle tissue is less variable with age, but striated muscle symplasts are sometimes completely absent in urethral biopsies from elderly patients. With age, the vascularization and density of the innervation decrease in the urethral structures, but the content of connective tissue in the external urethral sphincter increases. Urinary tract mobility at young women is more pronounced than at older women. The apparent insufficiency of modern investigations about age-related changes in the lower urinary tract indicates the relevance and need to continue studying of the organ and tissue transformation in the urinary system during aging, this may be important for determining the etiology and pathogenesis of some pathological conditions, such as stress urinary incontinence, as well as for differential diagnosis between age norm and pathology.

Robot-assisted operations as widely used in urology, gynecology, general and cardiovascular surgery are considered by many experts as a new 'gold standard' of surgical treatment of various diseases in developed countries. Robot-assisted radical prostatectomy for prostate cancer is the most common robotic procedure. Better functional outcomes of robot-assisted radical prostatectomy are due to another (new) understanding of pelvic surgical anatomy, new approach implying dissection and preservation of external urethral sphincter and neurovascular structures. Prostate neuroanatomy, various approaches to preserve neurovascular structures and own experience of nerve-sparing robot-assisted radical prostatectomy with functional results are reviewed in the article.

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.

We studied correction of micturition disorders in 9 patients with neurogenic dysfunction of the bladder resistant to conservative treatment. Four patients had neurogenic detrusor hyperactivity and 5 patients had detrusor-sphincter dyssynergia. Injections of botulinic toxin preparation (lantox) were made in the wall of the bladder under endoscopic control in detrusor neurogenic hyperactivity. Women with detrusor-sphincter dyssynergia received transperineal injections of lantox in the region of external urethral sphincter. Men received botulinic toxin directly into the region of external urethral sphincter in urethroscopy. Positive results were achieved in all the cases confirming high efficacy of the method.

Chronic pelvic pain syndrome (CPPS), often observed in practical urology, in some cases is accompanied with obstructive voiding due to inadequate relaxation of the urethral striped sphincter. TUR of the bladder neck in such cases is low effective and patients have to do intermittent autocatherization. Lantox, a botulinic toxin A, was used in a woman suffering from CPPS for 24 years. The patient has undergone two TURs of the bladder cervix. As the effect was insignificant she had to do regular intermittent autocatheterization of the bladder for 4 years. A lantox injection (100 units) was made in the external urethral sphincter. A subjective response (a 73.3% reduction of pain intensity) and voiding improvement shown by an urodynamic investigation were achieved as well as the absence of residual urine which abolished the need in autocatheterisation. The case demonstrates high efficacy of lantox both in relief of CPPS and improvement of voiding.

The new device--CoreFlow Soft Stent--was used for diagnosis of causes of incomplete bladder emptying (IBE) in 19 men with neurogenic diseases. Group 1 consisted of 8 men with IBE and prostatic adenoma. Group 2 consisted of 11 men with IBE but no prostatic adenoma. The CoreFlow Soft Stent comprises an introducer and a stent. Different active lengths of the stent are available to match it to the length of the prostatic urethra. The stent has an anchoring balloon situated in the bladder and a second anchor located distally to the external sphincter. CoreFlow was introduced in a similar way as an ordinary Foley catheter. The bladder was filled with 200 ml of saline solution through the introducer and the stent. The introducer part was then separated from the stent part positioned in the prostatic urethra. The stent part is connected to the integral "pull-thread" device which runs through the urethra ending outside the meatus. Reposition of the stent using the special thread opens the striated urethral sphincter. Out of 8 patients with prostatic adenoma and neurogenic diseases 4 could urinate with the stent part positioned in the prostatic urethra indicating that prostatic adenoma was the cause for IBE. These patients have undergone TUR. The other 4 patients of group 1 and 11 patients of group 2 could urinate only using Valsalva manoeuvre and after reposition of the stent for opening the striated urethral sphincter. This allowed us to conclude that these 15 patients suffered from detrusor underactivity. Our experience indicates that CoreFlow Soft Stent is a simple device for diagnosis of the causes of IBE in men with neurogenic diseases.

Aim: To investigate safety and efficacy of botulinum A toxin external urethral sphincter injection in the treatment of patients with detrusor external sphincter dyssynergia (DSD) and neurogenic low detrusor contractility (DC)., Material and Methods: The study included 21 patients with DSD and 27 patients with low DC between 17 and 73 years of age. The diagnostic scheme consisted of voiding diary for 72 hours, laboratory tests, ultrasound investigation with measurement of residual urine volume, urodynamic investigation and neurologic examination. 100 units of botulinum A toxin (botox, allergan) were injected into external urethral sphincter paraurethrally in women and transurethrally in men., Results: 6 months after the toxin injection good results were achieved in 6 out of 9 DSD patients with spontaneous micturition; physiologic micturition was restored in 5 out of 8 patients who had performed intermittent self catheterization and in 3 out of 4 patients with suprapubic fistula and urethral catheter. As for patients with neurogenic low DC, good results were achieved in 6 of 8 patients who had had spontaneous micturition; physiologic micturition was restored in 13 out of 14 patients who had performed intermittent self catheterization and in 3 out of 5 patients with suprapubic fistula and urethral catheter. There were neither complications nor side effects., Conclusion: Botulinum A toxin external urethral sphincter injection demonstrated high efficacy in patients with DSD and neurogenic low DC.

In experimental model, imitating lower urinary tract was detected the significance of urodinamic researches for diagnostic of stress incontinence. We suggested math formules for determine opening and closing of sphincter and their connection to the bladder volume, on the basis of uroflowgrame analysies, where was noted the uncontroled leakege of liquid (urine). By cystometry was detected the connection between opening of urethral sphincter and the pressure of the bladder, when was determined the stress incontinence. It was concluded that urodinamic figures have significant diagnostical value at stress incontinence and could help in choosing conservative treatment or surgery.

Urodynamic and microcirculatory parameters were studied in 70 females aged from 21 to 70 years with hyperactive urinary bladder (HAUB) and 15 females free of diseases of the lower urinary tract. HAUB patients appeared to develop microcirculatory disorders in the wall of the bladder manifest as slow circulation resulting in detrusor hyperactivity responsible for HAUB symptoms. HAUB development is accompanied with urodynamic disorders - enhancement of detrusor contractility and that of urethral sphincter with growing amplitude of their electric activity leading to potentiation of bladder evacuatory ability. Different conservative treatments were evaluated for their influence on urodynamics and microcirculation in females with HAUB.

Botulinic toxin (BT) is a new method of lowering intraurethral pressure in symptoms of obstructive voiding in patients with neurogenic dysfunction of the lower urinary tracts (LUT). Transperineal introduction of 100 units of BT type A (botox, Allergan) was used under electromyographic control into the external urethral sphincter of 9 patients (6 males and 3 females) with LUT neurogenic dysfunction aged 17 to 68 years (mean age 37.2 years). Two patients had subnormal detrusor contractility due to myelodysplasia and diabetic polyneuropathy, two other patients--non-incontinent striated urethral sphincter after hemorrhagic stroke and spinal contusion, five patients suffered from detrusor-sphincteral dyssynergia (DSD) resultant from Schmorl's hernia, multiple sclerosis, Charcot-Marie disease and ischemic stroke of the spinal cord. Three patients had cystostomic drainage. The rest of the patients complained of dysuria, three patients performed self-catheterization, mean volume of the residual urine was 170 ml (180-240 ml). In 10 days residual urine was not found in 2 patients with subnormal detrusor contractility and in 4 patients with DSD. Abdominal pressure fell from 75 to 39 cm, on the average. In DSD patients maximal detrusor pressure fell from 59 to 29 cm, on the average. Mean maximal urinary flow rate rose from 4.3 to 9.6 ml/s. In 20 days, on the average, suprapubic fistula healed in all the patients. In a month, therapeutic effect persisted in all the patients. Complications, side effects were not registered. BT treatment to induce adequate urine evacuation in neurological patients is a promising approach in neurourology. Further studies should find answers to questions about regimen of BT introduction, loss of sensitivity, new indications in urology.

Electromyography (EMG) with needle electrodes of urethral and anal sphincters was performed in 32 patients with stress enuresis (SE). All the patients received conservative treatment as pelvic fundus exercise by Kegel (17 patients), use of vaginal cones (4 patients), ESMP-15-1 device electrostimulation (11 patients). In treatment failure, SE was corrected surgically. The response was assessed 8 weeks after the treatment. Satisfactory results were obtained in 23(72%) women. Reinnervation of urethral sphincter and the anus of different severity was found in 13(41%) and 30(97%) patients, respectively. Denervation in urethral and anal sphincter occurred in 4(13%) and 6(19%) patients, respectively. The comparison of the results of treatment and EMG findings has shown that good results were achieved only in patients with moderate reinnervation of the sphincters. Patients with denervation and/or severe reinnervation of the sphincters did not benefit from the conservative therapy or its result was minimal. It is shown that needle EMG is a reliable method of assessing the condition of urethral and anal sphincters and helps to make timely choice of SE treatment in women.