[Surgical treatment of urinary incontinence in geriatric patients].

INTRODUCTION: Recently, there has been a steady upward trend in life expectancy, so it is extremely important to remember some of the features of the body associated specifically with aging. Thus, an important topic for discussion is the issue of ensuring the quality of life of an elderly woman. The prevalence of urinary incontinence in patients of the older age group leads to significant restrictions in their social life. Surgical treatment using general and regional anesthesia has significant contraindications due to age and comorbidities. In this regard, in some cases, local anesthesia is the method of choice of anesthesia in this category of patients. PURPOSE OF THE STUDY: Evaluation of the possibility of using local anesthesia in the surgical treatment of stress urinary incontinence in geriatric patients. MATERIALS AND METHODS: We analyzed the results of surgical treatment of stress urinary incontinence in 42 patients. The mean age of the patients was 78+/-4 years. All patients were treated for urinary incontinence using mini loops under local anesthesia. Pre- and postoperative examination included vaginal examination in mirrors, cough test, cystoscopy (if indicated), uroflowmetry, ultrasound examination of the pelvic organs and bladder, bacterial culture of urine with determination of sensitivity to antibiotics. Taking into account the advanced age of the patients, the protocol of the preoperative examination included the obligatory performance of ultrasound Doppler examination of the veins of the lower extremities and echocardiography. RESULTS: The duration of the operation averaged 22+/-5 minutes. Complications requiring a change in the course of the operation were not registered during the operation. 1 month after the operation, at the control examination, the cough test was negative in 40 (95,2%) patients. 2 (4,8%) had a positive cough test. After 6 months, out of 40 (100%) successfully operated patients, 4 (9,52%) had urine leakage during the cough test. The maximum follow-up period for patients was 12 months. Out of 40 (100%) patients with a negative cough test after surgery, it was possible to track the long-term results of treatment only in 33 (82,5%) patients. After evaluating the results of 33 (100%) operated patients after 12 months, it was found that in 30 (90,9%) patients the symptoms of urinary incontinence were completely absent, in 3 (9,09%) there was a recurrence of urinary incontinence. CONCLUSIONS: Surgical treatment of stress urinary incontinence using a synthetic loop under local anesthesia is effective and safe in geriatric patients.

[Urinary incontinence in women and its impact on quality of life].

The prevalence of urinary incontinence at a young age is 20-30%, gradually increasing to 40% among older women. Urinary incontinence affects many areas of the patient's life, including social, psychological, work, sexual, etc. The main causative factors, which also influence on its severity, include age, pregnancy, childbirth and obesity. To date, there are many treatment methods for stress urinary incontinence. However, more preference is given to the sling procedures, in which mesh is placed under the middle part of the urethra. Despite being the "gold" standard for the treatment of stress urinary incontinence, it is difficult to determine indications for surgical treatment, since "nonmedical" view of the patient's problem is often required. The low awareness of primary care physicians about the possibilities of treating urinary incontinence often leads to an erroneous opinion in patients about their disease and methods of treatment. Many patients regard this condition as an integral part of aging, avoid situations in which urinary incontinence is possible, which limits daily activities, sexual activity, sports and other areas of life. Based on the latest data, a review of the literature on urinary incontinence in women, risk factors, as well as existing methods of surgical correction are presented in the lecture. Particular attention is paid to the impact of urinary incontinence on the quality of life of patients and current methods for its assessment.

[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[linical case: enterocele after radical cystectomy with heterotopic bladder plastic surgery].

CLINICAL CASE: The article presents a clinical case of a 58-year-old patient T.N.V with enterocele following radical cystectomy with heterotopic neobladder.

[Vaginal approach for the surgical treatment of pelvic organ prolapse].

A review of current literature on the results of surgical treatment of patients with pelvic organ prolapse by vaginal approach is presented in the article. The relevant issues are the safety and efficiency of using mesh implants for the surgical correction of pelvic organ prolapse. Most experts recognize a need for further improvement of vaginal reconstruction techniques using synthetic meshes, however, current restrictions in a number of countries significantly impact on the respective studies. Despite the many scientific works and various publications, to date there is no single concept of the pelvic organ prolapse. It is necessary to conduct multicenter clinical studies in order to further develop clinical guidelines and to determine a place of these operations in the surgical treatment of pelvic organ prolapse.

[Urethral diverticulum in female].

Urethral diverticulum is one of the rarest female urological diseases, which is characterized by various manifestations, ranging from an asymptomatic to severe urinary disorders, pain and dyspareunia. The aim of this work is to present a clinical observation of female urethral diverticulum with a description and discussion of its etiology, diagnosis, and treatment. Clinical observation is dedicated to 40-year-old woman with complaints of pain in the urethral area. The patient underwent ureteral stenting followed by a diverticulectomy. Vaginal diverticulectomy is the gold standard for treatment. The specialist performing such interventions should be aware for possible intraoperative complications. It seems appropriate to perform the surgical treatment of female urethral diverticulum in specialized centers with an experience in female urethral reconstruction.

[Sling procedures to treat urinary incontinence in the Russian Federation].

Surgical treatment of urinary incontinence using synthetic slings is one of the most frequently used procedures in modern urogynecology. The availability of almost identical surgical sets manufactured by different companies can at times significantly hamper the choice of a synthetic sling for a particular patient. This article presents a brief overview of the literature on the efficacy and safety of sub-urethral synthetic slings registered in the Russian market.

[Surgical treatment of stress urinary incontinence].

OBJECTIVE: Urinary stress incontinence considerably decreases the life quality of women, which makes search for effective methods of treatment essential. The research presents results of surgical treatment of 230 patients with stress urinary incontinence between 2011 and 2014. MATERIALS AND METHODS: Efficiency of treatment of urinary incontinence in women, using Tension-free Vaginal Tape (TVT-O) and mini-sling Ophira was presented. The evaluation was made out of complaints and physical examination in target groups, including patients with concurrent genital prolapse and mixed urinary incontinence. For correct diagnosis all patients were submitted to urodynamic and ultrasound tests. In case of need M-cholinomimetic drugs were applied. To evaluate different complaints 5-graded visual analogue scale was worked out. Results of cough stress test were taken as main objective way to estimate effectiveness of the treatment. RESULTS: The research showed that application of TVT-O mesh and mini-sling Ophira turned out to be highly effective in treatment of urine stress incontinence in women. Among short-term complications urinary retention was most common (3,5 percent). To correct those complications alfa-adrenergic agonists, physiotherapy, and acupuncture were applied. Erosions of vaginal mucous had developed at the place where meshes were planted in 1,3 percent of cases. Only once it required mesh excision.