[Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury].

AIM: to evaluate the effectiveness of fesoterodine for the prevention of autonomic dysreflexia (AD) in patients with neurogenic bladder dysfunction (NBD) after spinal cord injury (SCI). MATERIALS AND METHODS: a total of 53 patients with AD were included in the study. In the main group (n=33) patients received fesoterodine 4 mg per day for 12 weeks as a treatment for neurogenic bladder dysfunction and prevention of AD. In the control group (n=20), patients were monitored for 12 weeks without specific treatment. The assessment was based on the results of ADFSCI and NBSS questionnaires, daily blood pressure monitoring with the completion of a self-observation diary, cystometry with simultaneous monitoring of blood pressure and heart rate. RESULTS: In the main group there was a significant decrease in episodes and severity of AD according to ADFSCI questionnaire and an improvement in the quality of life according to NBSS questionnaire compared to the control group (p<0.001). Also, in the main group, the number of episodes of AD and systolic blood pressure decreased. The maximum bladder capacity and bladder compliance increased (p<0.001), and the maximum detrusor pressure and systolic blood pressure when the cystometric capacity was reached, decreased significantly (p<0.001) in the main group compared in comparison with the control group. CONCLUSION: Fesoterodine at a dosage of 4 mg for 12 weeks reduced the severity of symptoms of AD in patients with SCI and NBD, which was manifested by the stabilization of blood pressure and a decrease in the number of episodes of AD, which significantly improved the quality of life. Also, the drug led to a significant improvement in urodynamic parameters during cystometry, in the form of a decrease in detrusor pressure and an increase in cystometric capacity. We can conclude that fesoterodine is effective in the prevention of AD in patients with NBD after SCI.

[Premature ejaculation: the main physiological mechanisms and new approaches to the treatment].

Premature ejaculation (PE) is characterized by an early ejaculation, which occurs within 1 minute after or before vaginal penetration. PE is the most common sexual problem and leads to a number of negative psychological consequences. To understand the etiopathogenesis of PE, it is necessary to understand the physiological mechanisms of the ejaculatory reflex. A group of galanine-ergic lumbar spinothalamic cells (LSt cells) with their numerous projections to various structures of the central nervous system plays a crucial role. The main approaches to the treatment of PE are based on the inhibition of glans sensitivity. In recent years, most of the studies on PE are dedicated to various technologies of reflexotherapy and a possibility of biofeedback. We have analyzed the available literature data and explained the main links of ejaculatory reflex, as well as possible approaches to treatment.