[Features of neurohumoral regulation in children with combined dysfunction of the pelvic organs].

During examination of 165 children aged 5 to 15 years (primarily identified during planned monitoring in Petrozavodsk children's institutions) with dysfunctional urination and encopresis without organic lesion of the central nervous system, autonomic dysfunction syndrome (ADS) was revealed. According to the results of urological examination, which was supplemented with the registration of spontaneous voiding rate and counting the radial pulse, overactive bladder syndrome and insufficient relaxation of the pelvic floor muscles during urination and defecation were detected; relationship between the number of heart rate (as a marker of sympathetic nervous system activity) and the effective volume was identified. It was revealed that the children with ADS in the presence of tachycardia show intermittent decrease of effective amounts of urination, and have residual urine. The standard course of treatment using colon hydrotherapy and biofeedback to activate cystic and obturator reflex caused a positive but short-term therapeutic effect; clinically and statistically significant increase in the effective volume of the bladder was not achieved, despite the reduction in residual urine volume. During the course of treatment using methods of biofeedback, bladder volume remained almost unchanged and tachycardia persisted, indicating the continued oppression of the sympathetic activity. The course of treatment using nootropic drug picamilon and alpha-adrenoblocker doxazosin with peripheral actions allowed to restore the reservoir and evacuation functions of the bladder, to achieve a regular bowel movement without encopresis. It was revealed that the combined dysfunction of pelvic organs occur in children with high activity of the sympathetic division of the ANS, which has a direct impact on the accumulation phase of voiding cycle and relaxation of the pelvic floor muscles.

[Validation of the treatment of the neurogenic bladder in children with myelodysplasia using pikamilon]. / Obosnovanie lecheniia neirogennogo mochevogo puzyria u detei s mielodisplaziei pikamilonom.

An original Russian drug pikamilone with central (vegetotropic, vascular) and peripheral (vasodilation) mechanism of action and m-cholinolytic atropine were investigated for effect on detrusor function in the accumulation phase in 26 children with neurogenic bladder due to myelodysplasia. The detrusor function was assessed at retrograde cystometry performed before and after the drugs administration. The cystotonograms were estimated using a computer program of Relief urosystem according to the standard and additional indices. Pikamilone was found to potentiate the effects of atropine. This may be due to improvement of circulation and reduction of detrusor hypoxia. It is stated that selective chemotherapy of neurogenic bladder is uneffective. The preference should be given to combination of the drugs affecting main components of its dysfunction pathogenesis. Pikamilone should be referred to basic drugs for treatment of neurogenic bladder in spinal patients as its combination with atropine possesses a unique efficacy in restoration of the reservoir function of the bladder.