[Efficiency and safety of silodosin for treatment of lower urinary tract symptoms, associated of benign prostatic hyperplasia].

Benign prostatic hyperplasia commonly is the most common cause of bladder outlet obstruction and can result in storage and micturition symptoms in men older than 40 years. Nowadays the 1-adrenoreceptor antagonists are the first-line drug for treatment of the lower urinary tract symptoms (LUTS). However, 1-adrenoreceptors are known to be present in other tissues and this fact could be a reason of potential risk of adverse events, associated with changes in peripheral vascular tone, such as orthostatic hypotension, syncopal states, dizziness, etc., especially in patients of advanced age, and those affected by cardiovascular diseases and taking essential drugs. A highly selective -adrenergic blocker silodosin is characterized by a lower rate of mentioned adverse events, comparable with placebo. Silodosin is also highly effective in treating of both types of LUTS in these patients, both as monotherapy and in combination with other drugs. A detailed analysis of clinical data confirming the high efficacy and safety of silodosin is presented in this review of the literature.

[Comprehensive pharmacologic management of overactive bladder].

Overactive bladder (OAB) is a common and bothersome condition manifested by urgency, frequent urination, significantly impairing patients quality of life. The article presents an overview of the evidence on pharmacotherapy of neurogenic and idiopathic OAB. Selective M3 receptor blockers have been shown to be the medications of choice in treating these patients. Many studies have shown that solifenacin 10 mg is a starting dose for patients with OAB. Mirabegron (Betmiga) is the only 3-adrenergic receptor agonist approved for primary treatment of OAB patients refractory to anticholinergics or have their side effects. It seems promising to use this drug, both as monotherapy and concurrently with anticholinergic agents to improve treatment results in patients with idiopathic and neurogenic OAB.

[Validation of urgency scale to detect and assess urgency in patients with overactive bladder].

INTRODUCTION: Urinary urgency is a hallmark symptom of overactive bladder (OAB). Several scales have been used to measure urgency. Taking into account the exceptional importance of these scales, it is important to determine their reliability, which depends directly on the accuracy of the wording and clarity to patients. AIM: To determine reliability of Russian-language translation of the Patient Perception of Intensity of Urgency Scale (PPIUS) in identifying and assessing urgency in patients with OAB. MATERIALS AND METHODS: The study included 50 patients (46 women and 4 men) aged 19 to 70 years (mean age 56.5 years). At the time of entering the study, all patients had symptoms of OAB and received anticholinergic therapy for at least 3 months with any drug approved for the use in Russia. PPIUS scale validation was performed by assessing reliability, absence of "habituation" effect of and indicators of convergent, divergent, and content validity. RESULTS: The Russian version of voiding diary with PPIUS scale was found to have good psychometric properties and besides the content validity also had significant signs of convergent and divergent validity. CONCLUSION: The Russian-language versions of urgency scales PPIUS and TUFS can be considered validated for using in clinical practice and in clinical and non-interventional studies in patients with OAB in Russia.

[High doses of trospium chloride in patients with idiopathic overactive bladder. Data of large-scale, multicenter observational program Resource].

PURPOSE: Evaluation of the efficacy and safety of different doses of trospium chloride in patients with idiopathic overactive bladder. MATERIALS AND METHODS: Large-scale observational program "Resource" included 669 patients with idiopathic OAB - 359 women and 310 men. At the first visit, all patients were assigned to use of trospium chloride at a standard dose of 45 mg per day. The results of treatment were evaluated during follow-up visits at 3, 6, 9 and 12 weeks. Depending on the results of examination, the dose was reduced in the presence of adverse events and increased in case of insufficient treatment effects. RESULTS: After 12 weeks, 102 patients have been receiving the drug at a dose of 30 mg/day, 241 - at a dose of 45 mg/day, 257 - at a dose of 60 mg/day, and 22 - at a dose of 75 mg/day. CONCLUSIONS: Individual approach to the selection of doses of trospium chloride in patients with idiopathic OAB can be quite effective and safe measure to achieve optimal clinical outcome with a good safety profile.

[NERVE GROWTH FACTOR IN THE URINE OF PATIENTS WITH IDIOPATHIC DETRUSOR OVERACTIVITY AND OVERACTIVE BLADDER WITHOUT DETRUSOR OVERACTIVITY].

The purpose was to determine the concentration of the neurotrophin nerve growth factor in urine to assess its possible role as a marker in the diagnosis of various forms of overactive bladder. The study included patients with urinary frequency and urgency: 21 patients with idiopathic detrusor overactivity, 18--with overactive bladder without detrusor overactivity and 11 healthy volunteers (control group). The level of nerve growth factor in the urine was determined in all participants of the study by the enzyme immunoassay (ELISA). In the control group the average ratio of nerve growth factor level to the level of urine creatinine was 0.2 ± 0.06, in patients with overactive bladder without detrusor overactivity -0.33 ± 0.06 (p > 0.05). In patients with idiopathic detrusor overactivity the rate was significantly higher and amounted to 6.04 ± 0.9 (p < 0.05). Therefore, measurement of the concentration of nerve growth factor in the urine may be used for differential diagnosis of the presence or absence of detrusor overactivity in patients with overactive bladder.

[INJECTION OF BOTULINUM TOXIN TYPE A IN THE BLADDER DETRUSOR AND SUBMUCOSA IN PATIENTS WITH OVERACTIVE BLADDER WITHOUT DETRUSOR OVERACTIVITY].

The objective of the study was to compare the efficacy and safety of injections of botulinum toxin type A in the submucosal layer of the bladder and in detrusor in patients who were refractory to anticholinergic therapy of overactive bladder without detrusor overactivity. 100 U botulinum toxin type A was diluted in 10 ml of 0.9% saline and injected with 0.5 ml (5 units) of this solution in 20 points of the bladder (the back and side walls except Letto triangle). In twenty-two patients (the first group) botulinum toxin was injected into the submucosal layer of the bladder, while in 34 patients (second group) - into the detrusor. In the first group after 1 and 3 months 3 (14%) patients and after 6 months 2 (9%) patients had positive treatment outcomes (improvement of symptoms in more than 50%). In 22 (65%) of the 34 patients of the second group positive results were observed at 1 and 3 months and in 17 (50%) - at 6 months. After 9 months, all patients had a relapse of urgent and frequent urination. Difficulties in emptying the bladder were observed in three (9%) of the second group patients who had to resort to periodic self-catheterization for 2-20 weeks. The obtained results allow us to state that the injections of 100 U of botulinum toxin type A in the submucosal layer of the bladder are ineffective in patients with overactive bladder without detrusor overactivity, whereas injections in the detrusor lead to a statistically significant improvement in symptoms of urgent and frequent urination for 6 months.

[Long-term outcomes of the use of α-blockers tamsulosin in men with lower urinary tract symptoms and benign prostatic hyperplasia].

The retrospective evaluation of efficacy and safety of tamsulosin omnik (0.4 mg once a day) for 8 years in 17 patients with BPH and LUTS was performed. At the time of appointment of tamsulosin, mean age of patients was 61.9 years (range, 51 to 69 years). Efficacy of tamsulosin was evaluated based on the change of obstructive and irritative symptoms according to items of I-PSS scale, maximum urinary flow rate, residual urine volume and prostate volume. The study found that factors for favorable prognosis against the background of use of tamsulosin include moderate LUTS, small- or medium-sized BPH, maximum urinary flow rate of not less than 9 ml/s, and residual urine volume not more than 100 ml.

[Botulinic toxin type a in combined treatment of males with chronic pelvic pain syndrome in combination with bladder emptying dysfunction].

The efficacy of various treatment of chronic pelvic pain syndrome in combination with bladder emptying dysfunction was comparatively analysed for 31 male patients. Statistics show that current schemes of medication including antibacterial, nonsteroid anti-inflammatory drugs, alpha-adrenoblockers are not highly effective in such patients. Transrectal microwave hyperthermia is effective in males with chronic pelvic pain syndrome but the response is short - 3 months maximum. The highest and the longest effect in patients with chronic pelvic pain syndrome in combination with bladder emptying dysfunction was achieved after injections of 100 units of botulinic toxin type A into the cross-striated sphincter of the urethra.

[Botulinum toxin type A in patients with overactive bladder].

The aim of the study was to investigate safety and efficacy of intradetrusor injection of 100 units of botulinum toxin type A in 26 patients with refractory overactive bladder. The diagnostic scheme consisted of 72 h diary, laboratory tests, ultrasound investigation with measurement of residual urine, urodynamic investigation and neurological examination. The patients were divided into 3 groups: 14 patients with idiopathic detrusor overactivity (DO), 9 with neurogenic DO, and 6 with overactive bladder without DO. 100 units of botulinum toxin type A mixed with 20 ml of normal saline were injected into the detrusor sparing the trigone. Clinical and urodynamic evaluations were performed before the injection and 1, 3 and 6 months after it. The patients with idiopathic DO and overactive bladder without DO showed improvement of such clinical symptoms as frequency, urgency, nocturia and urgent incontinence which lasted for at least 6 months. Patients with neurogenic DO had improvement of the clinical symptoms only for one month after treatment. We had no patients who exhibited acute urinary retention or residual urine. Thus, 100 units of botulinum toxin type A injected into the detrusor is an effective, safe and well tolerated treatment for patients with idiopathic DO and overactive bladder without DO in whom an anticholinergic medication has failed.