[Results of three-year clinical study of prostamol uno efficacy and safety in patients with initial symptoms of prostatic adenoma and risk of its progression].

Prostamol Uno (PU) efficacy and safety were studied in a multicenter, open-population, randomized and comparative trial. PU was given in a single daily dose 320 mg for 36 months to 50 patients with initial symptoms of prostatic adenoma (PA) in comparison with 50 matched controls. The trial evaluated PU action on the symptoms progression and quality of life with application of questionnaires IPSS and QoL (BS). It was found that PU treatment relieved PA symptoms by IPSS, while these symptoms progressed in the controls. QoL improved in the study group and deteriorated in the control one. Administration of PU significantly increased urinary flow rate though in the controls urinary flow rate decreased, size of the prostate diminished and increased, respectively. Changes in the PSA were not seen and were insignificant, respectively. The results of the study say that prostamol Uno in a dose 320 mg/day can prevent PA progression without side effects.

[Efficacy and safety of prostamol-UNO in the treatment of patients with initial symptoms of prostatic adenoma and risk of progression: 2 years of investigations].

The article presents 2-year pilot results of a multicenter, randomized, controlled trial of prostamol-UNO effects on symptoms progression, quality of life, tolerance and safety in patients with early prostatic adenoma. The drug was used in a single dose 320 mg/day for 36 months. Prostamol-UNO efficacy in arrest of the symptoms progression and quality of life was assessed with the use of IPSS and QoL (BS) questionnaires. Measurements were also made of changes in Qmax, urine volume, residual urine, size of the prostate.

[Trospium chloride in combined treatment of females with genital prolapse and overactive urinary bladder].

The trial of efficacy of trospium chloride (TC) in a dose of 45 mg/day in females with overactive bladder (OAB) symptoms preserved after genital prolapse (GP) surgical correction included 28 females (age 55-82, mean age 68.07 +/- 12 years). GP was corrected by means of vaginal hysterectomy and anterior colporraphy. Treatment results were assessed 3 months after surgery basing on urine diary. Overall TC efficacy reached 82%. Symptoms attenuated in patients with and without detrusor overactivity: voiding frequency reduced by 31 and 24%, imperative voidings reduced by 26 and 8%, mean urine volume rose by 28 and 19%, respectively. Side effects were mild. TC demonstrated good efficacy in OAB patients, it noticeably improved quality of life.

[The role of somatosensory evoked potentials in prognosis of efficacy of tibial neuromodulation in patients with hyperactive urinary bladder].

Registration of evoked brain potentials was used as a non-invasive and an objective method of diagnosis of the CNS diseases. Somatosensory evoked potentials (SSEP) in response to stimulation of the tibial nerve were studied in patients with hyperactive urinary bladder (HUB) to clarify SSEP role in prognosis of tibial neuromodulation (TNM) efficacy. Urodynamic parameters and SSEP were examined in 13 patients with symptoms of urinary accumulation disorders. Neurogenic HUB was diagnosed in 6 patients, idiopathic one--in 7 patients. TNM was delivered in 30-min weekly sessions (n = 12). Six of seven patients with a cortical potential responded to TNM. Of six cortical nonresponders a positive result was achieved only in two. Thus, patients with the cortical potential demonstrate better effect of TNM than those without the potential. It is suggested that TNM influences both sacral and supraspinal center of urination.

[Trospium chloride in the treatment of idiopathic and neurogenic detrusor overactivity].

The aim of the study was to investigate safety and efficacy of spasmex (trospium chloride) in patients with idiopathic and neurogenic detrusor overactivity. The study included 66 patients with idiopathic and neurogenic detrusor overactivity. The diagnostic scheme consisted of voiding dairy for 72 hours, laboratory tests, ultrasound investigation with measurement of residual urine volume, urodynamic investigation and neurologic examination. The patients were divided into 4 groups: 15 patients with idiopathic detrusor overactivity (DOA), 16 with neurogenic DOA, 23 with combination of DOA with benign prostatic hyperplasia, 12 with overactive bladder without DOA. Initial trospium chloride dose of 15 mg/day (5 mg 3 times a day) followed by dose titration to obtain clinical efficacy was used under residual urine volume control every week. The maximal dose was 45 mg. After 12 weeks reduction of micturation frequency was registered in all the groups. Administration of small dose trospium chloride (15 mg) resulted in subjective improvement in 63 (94.5%) patients. Only 3 patients persisted with the symptoms in whom the dose was raised to 30 mg and then to 45 mg/day. Thus, spasmex demonstrated high efficacy in patients with bladder overactivity. High efficacy and safety with low cost make spasmex a drug of choice in the majority of patients with overactive bladder symptoms.

[Botulinic toxin in patients with neurogenic dysfunction of the lower urinary tracts]. / Botulinicheskii toksin u bol'nykh neirogennoi disfunktsiei nizhnikh mochevykh putei.

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.

[Electromyographic evidence in conservative treatment of stress enuresis in women]. / Rezul'taty élektromiograficheskikh issledovanii pri konservativnom lechenii stressovogo nederzhaniia mochi u zhenshchin.

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.